Table 58.1
Indications for surgery
| Symptomatic epiphora with failed prior dacryocystorhinostomy |
| Common canalicular obstruction |
Table 58.2
Preoperative evaluation
| Elicit prior surgical history; method of prior DCR – endonasal or external; stent placement; any surgical complications; any relief of symptoms prior to recurrence |
| Probing and irrigation of canaliculi – determine that obstruction is at level of common canaliculus |
| Nasal exam to assess prior ostium site, presence of scarring, adhesions; rule out intranasal pathology and septal deviation |
| Consider dacryocystogram (DCG) to determine the presence of residual lacrimal sac remnant |
Introduction
Balloon dacryoplasty is a useful adjunct in failed dacryocystorhinostomy secondary to common canalicular obstruction. In these cases, bone removal is adequate and there is no lacrimal sac remnant present. Typically, recurrent epiphora without mucoid discharge is the primary symptom.
Probing should confirm the presence of a canalicular obstruction. Dynamic probing with intranasal endoscopic visualization aids in the diagnosis. Prognosis for success is typically less for common canalicular stenosis compared to failed DCR with a sac remnant. Combined balloon dacryoplasty and antimetabolite therapy will likely increase the chances of success.
Surgical Technique
Endonasal anatomy and dynamic probing
Intranasal examination is essential for proper surgical planning. The scarred ostium is seen on the lateral nasal wall and the middle turbinate cannot be easily distinguished ( Figure 58.1A ). Dynamic probing with a 3-0 Bowman probe helps to define the common canalicular obstruction ( Figure 58.1B ). If the obstruction is too dense to bypass, a lacrimal trephine (0.80 mm, Beaver–Visitec) may be used. The probe is also used to palpate for residual bone.
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