Inferior meatus surgery for distal nasolacrimal duct obstructions: long-term outcomes and treatment paradigm.

IMPORTANCE Epiphora is a symptom resulting from obstruction of the nasolacrimal system. Classically, dacryocystorhinostomy has been performed to relieve epiphora. However, this does not address distal obstruction. Inferior meatus (IM) surgery at or near Hasner's valve has been shown to have a 92.8% short-term success rate in treating distal nasolacrimal duct (NLD) obstruction. In addition, IM surgery for proximal obstruction has shown poor success rates. Differentiation between distal and proximal obstruction would allow for more appropriate treatment and improved patient outcomes. To date, no study has addressed long-term outcomes or the workup for distal and proximal NLD obstructions. OBJECTIVE To report long-term outcomes in a subset of patients with epiphora due to distal NLD obstruction who underwent IM surgery and to present a treatment paradigm to differentiate distal from proximal NLD obstruction. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review with follow-up telephone survey was conducted at a tertiary referral center. Participants were patients surgically treated for epiphora from July 2006 to March 2010. INTERVENTION Inferior meatus surgery was performed to relieve epiphora in patients with distal NLD obstruction. MAIN OUTCOMES AND MEASURES Improvement or resolution of epiphora. RESULTS Seventeen patients were contacted for follow-up; 13 patients responded, representing 18 nasolacrimal systems. One patient (2 sides) was excluded owing to the surgical specimen showing leukemic infiltrates. Mean time of follow-up was 6.2 years. Ten sides had distal NLD obstruction. Of the nasolacrimal systems with distal obstruction, 9 had long-term subjective improvement of symptoms (90%). No patient had nasal complications. CONCLUSIONS AND RELEVANCE Directed IM endoscopic surgery resulted in long-term improvement of epiphora in 90% of nasolacrimal systems when performed for distal NLD obstruction. A treatment paradigm was developed and is detailed herein.