Endoscopically controlled surgery of the lacrimal drainage system using a microdrill and silicone tubing

Purpose. Operative procedures to manage lacrimal outflow obstruction were m ade traditionally without endoscopic assistance. For dacryoendoscopy we pre viously used a 0.5-mm endoscope with a special wash cannula. We now use the microendoscope Vitroptic T for dacryoendoscopy and for endoscopically cont rolled surgery with a microdrill. Methods. In an attempt to perform microinvasive lacrimal surgery we use a 1 .1-mm endoscope (Vitroptik T) with a wash cannula,a channel for the microop tic and a channel for a microdrill. We report on our initial experiences an d on the results of eight patients with stenosis of the lacrimal outflow sy stem who were treated with an endoscopic microdrill and silicone tubing. On e patient had lacrimal stenosis after external dacryocystorhinostomy (DCR), and seven patients showed punctual stenosis in the nasolacrimal duct. Results. Using the dacryoendoscope (Vitroptic T) we were able to visualize pathologic changes of the lacrimal outflow system. Intraoperative situation s during dacryoendoscopy are demonstrated. The Vitroptic T allows dacryoend oscopy and endoscopically controlled surgery of the lacrimal drainage syste m. Three months after surgery in six patients (75%) the lacrimal outflow sy stem was patent with the silicone tube in place, and these patients had no epiphora. The patient with re-stenosis after external DCR showed patency. Conclusions. Dacryoendoscopy and endoscopic controlled surgery of the lacri mal drainage system enables atraumatic and minimally invasive surgery. The Vitroptik T with the microdrill allows endoscopically controlled microsurge ry. Possible indications for the microdrill are punctual stenosis and re-st enosis after external DCR.