Endoscopy of the lacrimal system

Bachground/aim-Until recently, diagnosis of disorders of the lacrimal syste m has depended on digital dacryocystography and on clinical examinations su ch as the fluorescein dye test, lacrimal probing, and irrigation. The lacri mal system and its mucous membranes can now be viewed directly with a lacri mal endoscope. While the first endoscopes were rigid and limited by poor pi cture quality in axial illuminations, the new generation of endoscopes are a great leap forward for new diagnostic and therapeutic approaches. Methods-132 patients ranging in age from 8 months to 73 years with nasolacr imal obstruction were referred to the lacrimal department. Diagnostic lacri mal imaging utilising various small calibre endoscopes less than 0.5 mm in external diameter was performed. The endoscopes are coupled to specially de signed lacrimal probes as well as a CCD camera and a video recorder. The im aging was performed during standard lacrimal probing and irrigation in an o utpatient clinic setting in 120 of 132 patients Results-All patients reported the pain of endoscopy as being similar to tha t of standard lacrimal probing and irrigation. No adverse effects such as b leeding or lacrimal perforation were noted. Endoscopic manipulation was not too difficult and the picture quality, depth of focus, and illumination we re satisfactory in all cases. The most common site of stenosis was the naso lacrimal duct (59 patients), followed by the lacrimal sac (39 patients) and the canaliculi (34 patients). In 25 patients, partial obstruction, rather than complete stenosis, was visualised as a narrow lumen, which widened dur ing irrigation. In 14 of 28 patients, obstruction was due to canalicular su bmucosal folds and was removed with laser. In addition, the colour and cons istency of the lining mucosa correlated with type of obstruction. Normal mu cosa is smooth and light pink in colour. Inflammatory changes manifest as t hickened and reddish grey mucosa. More complete stenosis is shown as fibrot ic plaques with grey white inelastic membranes. Conclusion-Lacrimal endoscopy is a new, non-invasive method used to view di rectly and localise obstructions precisely. It allows differentiation betwe en inflammatory partial, and complete stenosis. Endoscopy enables one to ch oose the appropriate surgical therapy for patients. Patients tolerated the procedure well without any adverse reactions or effects. While it may not r eplace standard probing and irrigation, this technique is an extremely usef ul adjunct in determining the proper surgical modality, ease, and tolerance of the endoscopic manipulation by patients, and obtaining sharp and clear images of the nasolacrimal outflow system anatomy and pathology. Differenti ation of various types of obstruction by precise location and severity can be achieved.