Relief of chronic epiphora by transantral vidian neurectomy.

One of the constant side-effects of a successful transantral vidian neurectomy, well-known among otolaryngologists, is the interruption of the secreto-motor nerve supply to the lacrimal gland. Since this secreto-motor nerve supply is concentrated in the nerve of the pterygoid canal (vidian nerve) this is only to be expected. This depression of lacrimation appears to be permanent, yet in some 300 recorded operations done over the last 7 years (Golding-Wood, I962; Hiranandani, I966; Gregson, I969) there has been no evidence of a subsequent keratoconjunctivitis sicca. It appears that the goblet cells of the conjunctiva take over and provide the eye with sufficient lubrication (Golding-Wood, I964). The occurrence of a severe case of unilateral epiphora after a major injury to the eye and lacrimal apparatus seemed to be a good opportunity to investigate the value of this side-action of vidian neurectomy, for, from the rhinological viewpoint, the patient had nothing to lose, and from the ophthalmological viewpoint there might be much to gain.