Retained stenting material - An unusual cause of dacryocystorhinostomy failure

Objective: To highlight a troubling cause of dacryocystorhinostomy (DCR) fa ilure and to alert ophthalmologists to the potential problems that can resu lt when stenting material is not removed and becomes retained after DCR. Design: Consecutive noncomparative case series. Participants: Twelve patients who underwent revision DCR from February 1994 to January 1997. Intervention: Endoscopic DCR, pre- and postoperative nasal endoscopy, preop erative computerized tomography (CT), and pre- and postoperative Jones test ing. Results: Fourteen revision endoscopic procedures were performed on 12 patie nts with recurrent epiphora following DCR. Failure was due to retained sten ting material in six patients, a small bony rhinostomy in three patients, e xcessive scar formation within the rhinostomy in two patients, and improper location of the rhinostomy in one patient. Preoperative endoscopy and CT s can each correctly identified the retained sponge or tubing in four of six patients. Conclusions: Fastening a small sponge to Silastic tubing and positioning it within the DCR site in an attempt to retard DCR stenosis can be associated with a poor outcome and should be avoided. The nasal endoscope provided ex cellent visualization of pathology within the lacrimal sac and was a valuab le tool. Retained stenting material should be considered in patients with p ersistent epiphora following DCR or intubation prior to any decision to com mit a patient to permanent Jones tube placement.