Treatment of nasolacrimal duct obstruction in adults with polyurethane stent

PURPOSE: To evaluate the efficacy of polyurethane nasolacrimal duct stents in the treatment of epiphora resulting from primary acquired nasolacrimal d uct obstruction in adults. MATERIALS AND METHODS: In 25 patients (21 women and four men with mean age of 44 years, range 20 to 74 years) with nasolacrimal duct obstruction, 28 h ollow polyurethane stents designed by Song and associates were placed under fluoroscopic guidance. The obstruction was complete in 20 lacrimal drainag e systems and partial in eight. The lacrimal sac size was normal or large o n dacryocystogram in all lacrimal drainage systems. A Ritleng probe was int roduced through the upper punctum and advanced past the obstruction. A guid e wire with a flexible tip was then introduced through the probe, over whic h the stent was advanced in retrograde fashion and placed into the lacrimal sac and nasolacrimal duct. Clinical success was defined by the demonstrati on of a completely patent lacrimal drainage pathway through saline irrigati on and no or minimal complaint of epiphora. RESULTS: Stent placement was technically successful in 26 of 28 lacrimal dr ainage systems (93%). The mean time of fluoroscopy screening was 3.2 minute s (range, 1.4 to 5.8 minutes). The overall success rate was 82% (23 of 28 l acrimal drainage systems). Two stents were completely occluded. In one lacr imal drainage system with minimal epiphora, the stented drainage pathway wa s partially occluded. The patients were followed up from 4 to 22 months (me an, 7.2 months). CONCLUSIONS: Retrograde placement of a hollow polyurethane nasolacrimal duc t stent is a technique that is simple and well tolerated by patients. This method achieves a high success rate and may be suggested as a nonsurgical p rocedure for adults with primary nasolacrimal duct obstruction and proper l acrimal sac size. The Ritleng probe facilitates the procedure. (C) 2001 by Elsevier Science Inc. All rights reserved.