[Double intubation technique for the treatment of epiphora in complicated cases].

PURPOSE The aim of this study is to present a surgical technique used to treat epiphora secondary to difficult cases of lacrimal pathway obstruction after fractures, previous surgery or anatomic abnormalities. METHODS From January 2001 to December 2002 we treated 27 patients with complicated lacrimal pathway obstruction secondary to fractures (10 cases), previous nasal surgery (4 cases), failure of a previous ipsilateral dacryocystorhinostomy (DCR; 6 cases), or failure of a previous contralateral DCR (7 cases). A DCR through an external approach was performed by placing a double concentric intubation in the lacrimal sac and nasal fossa, with the additional introduction of an interpositional silicone structure within a third hollow tube anchored to the sac entrance. RESULTS The results were evaluated according to the absence of tearing, the emptiness of the lacrimal meniscus, and the permeability of the lacrimal system after forced liquid infusion. Globally, the technique was effective in 85 percent of cases. The results were satisfactory in 90% of cases of postraumatic epiphora, in 75% of patients with previous surgery, in 83% of patients with previous ipsilateral DCR, and in 71% of patients with failed DCR in the contralateral eye. CONCLUSIONS The double intubation technique is a good option in lower lacrimal system obstructions when conventional techniques have a high index of failure.