Dacryoliths: Nonsurgical fluoroscopically guided treatment during dacryocystoplasty

PURPOSE: To evaluate dacryocystoplasty with fluoroscopically guided nonsurg ical removal of dacryoliths in the treatment of dacryolithiasis. MATERIALS AND METHODS: Ten patients with severe epiphora due to partial (n = 8) or complete (n = 2) obstruction of the nasolacrimal duct system associ ated with dacryolithiasis underwent fluoroscopically guided removal of dacr yoliths during dacryocystoplasty. Balloon dilation was performed initially to widen the nasolacrimal duct obstruction and to fragment dacryoliths. Thi s was followed by forced irrigation with saline solution through the canali culi. In patients with incomplete dacryolith washout, a 6.3-F sheath was ad vanced in a retrograde fashion into the nasolacrimal sac, and forced irriga tion was repeated with aspiration of the fragments through the sheath. In t wo patients with therapy-resistant dacryoliths, additional fragmentation of the concrements was performed with a gooseneck snare. RESULTS: Removal of dacryoliths was technically successful in all patients (complete removal, n = 6; partial removal, n = 4). During a follow-up perio d of up to 18 months, complete resolution of epiphora was achieved in five patients, and five patients showed partial resolution of their symptoms. CONCLUSION: Fluoroscopically guided removal of dacryoliths during dacryocys toplasty is a feasible nonsurgical therapy with good clinical results and m ay be used as an alternative to dacryocystorhinostomy.