Transcanalicular Approach to Adult Lacrimal Duct Obstruction: A Review of Instruments and Methods

Abstract

Developments in fiberoptic technology and increasing interest in minimally invasive surgery have fueled advances in transcanalicular surgery. This article presents a review of instruments and methods for diagnostic and therapeutic approaches to adult lacrimal drainage obstruction. Available endocanalicular probes, microendoscopes, lasers, microdrills, trephines, and antegrade lacrimal balloon catheters are discussed and compared. Developments in microendoscopy, laser transcanalicular dacryocystorhinostomy, laser canaliculoplasty, transcanalicular drilling and trephination, and transcanalicular balloon dacryoplasty are also discussed in detail. Transcanalicular surgery provides a minimally invasive approach to adult lacrimal drainage obstruction that may also address the pathology causing the obstruction. Long-term success rates of transcanalicular dacryocystorhinostomy appear to be improving, but cost and a paucity of data on long-term results continue to limit the use of transcanalicular surgery.

Comparison of endocanalicular laser dacryocystorhinostomy with and without endonasal procedures

“…Preservation of the pump mechanism of orbicularis oculi, improved cosmesis, being a simple outpatient intervention, shorter recovery period and operating time, and reducing morbidity are known advantages of minimally invasive surgeries over external DCR [11,12]. However, uniform surgical techniques and more reports on long-term success rates are required for minimally invasive surgeries to replace conventional surgery as a gold standard procedure for the treatment of NLDO.…”

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy

“…In a study on 40 consecutive adult NLDO patients by Owji et al (15) , the mean conjunctival normalization time after EX-DCR was 4.5 (range, [3][4][5][6][7][8] weeks. While the authors reported significant associations among normalization times, type of organism isolated from the lacrimal sac (particularly anaerobes and Streptococcus), a colony count of ≥10 3 , and presence of a silicone tube, they found no relationship between normalization times and the presence or duration of epiphora or the presence of previous attacks of acute dacryocystitis (15) .…”

“…Advantages of EN-DCR and TC-DCR include the absence of a cutaneous scar and decreased operative duration. The new TC-DCR has demonstrated safe utility in elderly patients with systemic diseases (4)(5)(6)(7)(8) . A unique combination of stasis and moisture in NLDO may create an optimal environment for the growth of lacrimal sac flora.…”

Comparison of Anatomical and Symptomatic Success in Transcanalicular Laser Dacryocystorhinostomy

“…8 As transcanalicular endoscopic dacryocystorhinostomy (TC-DCR) is a less invasive technique with shorter operating time on average 9 than EX-DCR what remains is to achieve the success rates of EX-DCR procedures. In this study we aimed to determine surgical success in TC-DCR patients using anatomical and symptomatic outcomes.…”