Injury to the lacrimal apparatus after endoscopic sinus surgery: Surgical implications from active transport dacryocystography

In order to evaluate the lacrimal drainage system injury after functional e ndoscopic sinus surgery, surgical records and postoperative active transpor t dacryocystography imaging of 31 patients were analyzed. Presence of the l acrimal bone dehiscence and no passage of the contrast material into the in ferior meatus were noted as the signs of injury to the lacrimal canal on ac tive transport dacryocystography. Bony dehiscence was detected in 53.2% of the operated sides but 20% of the nonoperated sides. No passage of the cont rast material into the inferior meatus was observed in 14.9% of the operate d sides. There were no cases of epiphora postoperatively. The lacrimal drai nage system injury was more frequently observed on the left sides operated. We conclude that lacrimal drainage system injury might occur in various ex tents during functional endoscopic sinus surgery. However, it does not nece ssarily result in postoperative epiphora. Performing the middle meatal antr ostomy in posteroinferior direction, and uncinectomy with backbiting forcep s or a shave! might help in reducing the lacrimal injury. Active transport dacryocystography can be adopted as an alternative diagnostic tool in detec tion of the lacrimal injury.