Microsurgical endonasal dacryocystorhinostomy with long-term insertion of bicanalicular silicone tubes.

OBJECTIVE To assess the results of microsurgical endonasal dacryocystorhinostomy with long-term insertion of single or double bicanalicular silicone tubes in canalicular (presaccal) and ductal (postsaccal) stenosis of the nasolacrimal duct system. DESIGN Retrospective follow-up of case series between 1992 and 1996. PATIENTS Thirty-eight patients were included in the study: 19 with ductal stenosis; 28 with canalicular stenosis; and 1 (a 6-month-old girl) with congenital agenesis of the lacrimal duct system. INTERVENTION Forty-seven endonasal microscopic dacryocystorhinostomies were performed on 38 patients. Bicanalicular silicone tubes were inserted, fixed in the nasal cavity, and left in place as long-term space holders. In patients with canalicular stenosis, a specially designed double bicanalicular tube was inserted for maximal dilatation of the lacrimal canals. The tubes are left in place as long as possible, ie, for months to several years. In cases in which there was recurrent obstruction following accidental tube extrusion, we simply inserted new tubes using a short-acting anesthesia. RESULTS With 1 procedure, 17 (91%) of the eyes that were surgically treated for ductal stenosis became symptom free. The success rate in the cases of canalicular stenosis was 72%. In the remaining 28% of patients with recurrent obstruction, endonasal revision surgery was performed with new insertion of bicanalicular tubes. With the new tubes in place, these remaining patients have also stayed largely symptom free (length of follow-up, 8 months to 5 years [average, 3 years]). CONCLUSIONS The routine insertion of bicanalicular tubes as long-term spacers has proved effective and has been tolerated without problems. A new aspect of our study is that in cases of canalicular stenosis or congenital agenesis of the lacrimal duct, which generally have a poor prognosis, the patients also benefit when our specially designed long-term double bicanalicular tubes are inserted in the lacrimal ducts.