RETROGRADE DILATION OF POSTSACCAL LACRIMAL STENOSIS

The causes of nasolacrimal duct stenosis in adults can vary greatly. I n general, the symptoms can also vary, but most cases share a tendency toward recurring inflammations in the prestenotic area. The treatment of these disorders is limited to either conservative therapy to contr ol inflammation or surgically invasive measures. By using balloon cath eters, usually applied in percutaneous transluminal coronary angioplas ty (PTCA), dilation of the relative postsaccal stenosis can be perform ed under radiographic control. An exact diagnosis using various testin g methods, including digital dacryocystography for detailed localizati on and documentation of any pathologic changes, is decisive to success . Only in cases of incomplete postsaccal stenosis is retrograde balloo n dilation of the distal nasolacrimal duct indicated. A guide wire, de signed for the PTCA balloon catheter set, is introduced via the canali culus to the nasal cavity antegradely and caught with a thin hook and pulled from the naris, under visual control with an image converter. T he balloon catheter is retrogradely threaded over the guide wire. The balloon is then placed at the site of the pathologic stenosis under ra diographic control and dilated with high pressure. To ensure the perme ability of the system, monocanalicular silicone intubation has to be p erformed immediately afterwards. This procedure has been performed suc cessfully on 6 patients with a follow-up of 6 to 27 months. These init ial results give rise to the hope that this minimally invasive, interd isciplinary technique represents a new alternative in the treatment of incomplete postsaccal lacrimal stenosis.