Nonsurgically placed nasolacrimal stents for epiphora: long-term results and factors favoring stent patency

The role of interventional radiology in the treatment of epiphora

Epiphora is a relatively common ophthalmologic affection representing almost 5% of clinical consultations in ophthalmology and it consists in the complete or partial obstruction of nasolacrimal duct, leading to insufficient drainage of tears. The traditional treatment is represented by surgery namely, external dacryocystorhinostomy (DCR). Despite the high success rate DCR has many disadvantages and limitations since it requires general anesthesia, it may arise in a permanent facial scar and it is often affected by the reobstruction of the anastomotic tract by fibrotic scars and osteogenic activity. Fluoroscopically guided interventional procedures are a therapeutic alternative to surgery for lacrimal duct system obstructions that can consist either in balloon dacryocystoplasty or in nasolacrimal stent placement. In both cases, a pre-operative imaging characterization of the occlusion is needed for a correct treatment planning. In this review, we propose to highlight the role of interventional radiology in the treatment of epiphora and the role of computed tomography dacryocystography (CTD) in depiction and the pre-interventional planning.

Endoscopic endonasal dacryocystorhinostomy with ostial stent intubation following nasolacrimal duct stent incarceration

PURPOSE

To study the feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with novel lacrimal ostial stent (LOS) intubation for patients with chronic dacryocystitis with incarceration of a previously implanted nasolacrimal duct stent (NDS).

METHODS

According to surgical procedure, 166 patients (167 eyes) were divided into two groups: EE-DCR with LOS intubation was performed on 126 patients (127 eyes) in the EE-DCR group; while external dacryocystorhinostomy (E-DCR) with silicone tube intubation was performed on 40 patients (40 eyes) in the E-DCR group. The LOS or silicone tube was retained for 3-6 months. All patients were followed up for 12-36 months. Success rate of tear drainage reconstruction (TDR) and complications were retrospectively compared.

RESULTS

Excluding patients with early detachment of the LOS or the silicone tube, or with incomplete follow-up period, 117 patients (117 eyes) in the EE-DCR group and 36 patients (36 eyes) in the E-DCR group were included. The mean surgical time was 45.8 ± 11.5 min in the EE-DCR group and 68.1 ± 23.8 min in the E-DCR group (p < 0.001). Intraoperatively, the lacrimal sac was observed to become very small and its walls were thin, hyperemic and fragile, firmly attaching to the NDS by fibrous bands in all eyes. Upon final review, success rate of TDR was 83.8% (98/117) in the EE-DCR group, while 58.3% (21/36) in the E-DCR group (p < 0.01). Failure of TDR due to ostial closure by excessive fibrosis occurred in 14 out of 19 patients in the EE-DCR group, significantly less than the 11 out of 15 patients with failed TDR in the E-DCR group (χ(2 )= 6.959, p < 0.01). No significant difference existed in failures due to granuloma occluding the ostium or common canaliculus obstruction.

CONCLUSION

EE-DCR with LOS intubation may be an effective procedure to manage the special subgroup of patients with chronic dacryocystitis with incarcerations of a previously implanted NDS.

Treating epiphora in adults with the Wilhelm plastic nasolacrimal stent: mid-term results of a prospective study

The objective of the present study was to evaluate, in a prospective, single-center study, the effectiveness of the Wilhelm-type stent used in interventional radiology for the management of epiphora. Patients (n = 104; mean age 64 [range 25–88]; 33 male and 71 female) with severe epiphora had the stents inserted (135 stents in 115 eyes) to treat obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 83 cases, chronic dacryocystitis in 31, cases and postsurgical status in 1 case. The overall technical success rate of stent placement was near 94%. Resolution of epiphora was complete in 105 cases and partial in 3 cases. During a mean 13-month follow-up (range 1 week to 28 months), the median duration of primary patency was 11 months, and the percentage of patency at 6 months was 60.8%, at 1 year was 39.6%, and at 2 years was 25%. Stents malfunctioned in 54 cases, and all were easily withdrawn except in 1 case. Of these 27 cases, patency recovered spontaneously in 9 and by way of a second stent in 18. Secondary patency was 50%. Factors presdisposing to lower primary patency are inflammatory etiology and location of the obstruction. The benefit of stent deployment is clear with respect to the resolution of epiphora in candidate patients for percutaneous treatment. Technical and/or design improvements would be welcomed.

Randomized comparison of nasolacrimal cryoplasty versus plastic lacrimal stenting in the management of epiphora in adults

PURPOSE

To evaluate the efficacy of plastic polyurethane stents compared with nasolacrimal cryoplasty in the management of epiphora in adults.

MATERIALS AND METHODS

Patients (N = 37; mean age, 64 years; range, 34-86 y; six men, 31 women) with severe epiphora with partial/complete obstruction of the nasolacrimal system were randomized to have a plastic stent inserted (n = 19) or to undergo balloon dilation cryoplasty (n = 18). Both procedures were conducted on an outpatient basis. Patency was assessed with Kaplan-Meier curves.

RESULTS

Initial technical success rate and immediate resolution of epiphora was complete in all cases. At 6 months of follow-up, outcomes were already significantly different between the treatment groups and hence the study was discontinued. Plastic stent placement achieved a primary patency rate of 59.6% at 6 months, compared with 12.4% in the cryoplasty group (P < .0004). Multivariate analysis indicated that other measured variables (sex, age, etiology, previous treatment, and the interventional radiologist's expertise) had no significant effect on the outcomes (P > .05).

CONCLUSIONS

Initial success was good in both treatment groups, with nasolacrimal plastic stent placement achieving a level of primary patency superior to the cryoplasty procedure for the relief of epiphora on short-term follow-up. However, long-term outcome evaluation is needed before stent placement can be recommended as an alternative to more established surgical procedures.

Long-term results of balloon dacryocystoplasty: success rates according to the site and severity of the obstruction

PURPOSE

To evaluate the long-term patency of lacrimal drainage system (LDS) after balloon dacryocystoplasty (BD) and to give the long-term success rates according to the severity and localization of the obstruction.

METHODS

Between May 1993 and December 2003, BD was attempted in 117 eyes of 108 patients with idiopathic-acquired LDS obstruction. Patients with active dacryocystitis, dacryolithiasis, traumatic obstruction or lacrimal mass, obstructions at the superior or inferior canaliculi lateral to the common canaliculus, and follow-up period less than 36 months were excluded from the study.

RESULTS

The results of BD were evaluated in 99 eyes of 94 cases. The obstruction was seen at the common canaliculus in seven eyes, proximal nasolacrimal duct in 70 eyes, and distal nasolacrimal duct in 22 eyes. The mean follow-up period was 100.0+/-38.4 months (range: 36-142 months). The long-term overall success rate was 40.8% (20/49 eyes) in complete obstruction and 68% (34/50 eyes) in partial obstruction. The clinical success rate was 57.1% in common canalicular (complete: 33.3%, partial: 75%), 50% in proximal nasolacrimal duct (complete: 38.5%, partial: 64.5%), and 68.2% in distal nasolacrimal duct (complete: 57.1%, partial: 73.3%) obstructions. The overall success was 54.5% (54/99 eyes) for the entire series at the last clinical follow-up visit.

CONCLUSION

The long-tem success rate of BD for the treatment of epiphora is low and is not comparable to conventional dacryocystorhinostomy. More predictable results can only be achieved in carefully selected patients and this procedure can be recommended in cases demonstrating partial obstruction of the distal nasolacrimal duct.

Efficacy of mitomycin C irrigation after removal of an occluded nasolacrimal stent

PURPOSE

Mitomycin C (MMC) acts as a potent fibroblastic inhibitor, and topical application of MMC is effective in preventing scar formation. The purpose of this study was to evaluate the safety and efficacy of MMC irrigation after removal of an occluded nasolacrimal stent from the lacrimal system.

MATERIALS AND METHODS

A total of 57 lacrimal systems after removal of an occluded stent were assigned to one of two groups: 23 lacrimal systems were irrigated with MMC after stent removal (MMC group), and 34 lacrimal systems were not irrigated with MMC after stent removal (non-MMC group). In the MMC group, the lacrimal systems were irrigated with 0.2 mg/mL MMC through the inferior lacrimal punctum for 3 minutes in three different sessions: immediately, 1 week, and 1 month after stent removal. The mean and cumulative patency rates after stent removal were calculated using the Kaplan-Meier method and were compared between the two groups using the log-rank test.

RESULTS

Stent removal and MMC irrigation were technically successful in all lacrimal systems. There were no side effects or complications associated with MMC use. The mean patency rate after stent removal was higher in the MMC group than that of the non-MMC group: 10.5 months (95% CI: 7.04, 13.91) versus 4.5 months (95% CI: 2.40, 6.63), respectively. There was a statistically significant difference in the cumulative patency rates after stent removal between the two groups (P = .005, log-rank test).

CONCLUSIONS

Mitomycin C irrigation is safe and effective in increasing patency rate of lacrimal systems after removal of an occluded nasolacrimal stent.

Surgical treatment of obstruction of the nasolacrimal ducts in patients with anatomical endonasal variants

The presence of anatomical endonasal variants (concha bullosa, nasal septal deviation, or hypertrophic turbinates) may cause more complications in patients with epiphora who have external dacryocystorhinostomy (DCR). The purpose of this study was to assess the results of surgical placement of a stent in 28 patients. They were randomised into two groups and had either DCR or placement of a Song's polyurethane stent. They were followed up for 18 months. Twenty-six patients had a good result. The success rate was 13/14 for those who had DCR and 13/14 for those who had a stent. Operating time was significantly less for placing a stent (mean (SD) 15 (2) minutes) compared with 40 (3) minutes for DCR (p <0.01). Placement of a polyurethane stent is an effective and short procedure for nasolacrimal obstruction, which is suitable for patients with unusual intranasal conditions.

Nasolacrimal stenting: toward improving outcomes with a simple modification of the song stent

The purpose of this study was to evaluate, in a prospective, single-center study, the effectiveness of Song's polyurethane stents, modified "in-house," in the percutaneous management of epiphora. Patients (n = 170; age range 18-83, mean = 64; 50 male, 120 female) with severe epiphora had the modified stents inserted (183 eyes/195 stents) to treat unilateral/bilateral and complete/partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 119 cases (61%) and chronic dacryocystitis in 76 (39%). The set designed by Song was used in all patients but modified by us such that the extreme end is cone-shaped. The original technique was slightly modified by us and the procedure was conducted on an outpatient basis. The initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 180 eyes and partial in 3. On follow-up (mean = 18 months; range: 2 days to 24 months), 165 of 195 stents (85%) remained patent. Primary patency rates at follow-up were 86%, 84%, 84%, and 79% in the first 6 months, second and third 6 months, and the present (24 months), respectively. Stents became obstructed in 30 patients, but all but 2 were easily withdrawn and 20 of these patients remained asymptomatic for a mean of 14 months (secondary patency of 67%). Following stent removal, the withdrawn stent was replaced with a new stent in the same intervention on 14 occasions. In another six cases, patency was re-established without the need of a second stent. The procedure is simple and safe, both in stent insertion as well as in mechanical de-blocking and withdrawal when occluded. Success was >80 % in the short term (1-year follow-up). Stenting failure does not preclude other treatment because with the modification that we had introduced, the extreme end of the stent becomes more accessible to mechanical de-blocking, withdrawal, and relocation. The levels of primary and secondary patencies are promising and warrant more extensive investigation.

Evaluation of Polyurethane Nasolacrimal Duct Stents: In Vivo Studies in New Zealand Rabbits

The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.

Long-term results and factors affecting patency after removal of nasolacrimal stents

PURPOSE

To retrospectively evaluate the long-term patency and prognostic factors affecting patency after removal of nasolacrimal stents.

MATERIALS AND METHODS

Lacrimal polyurethane stents were removed from 317 lacrimal drainage systems of 275 patients because the stent ceased to function, and immediate and maintained patency were determined with follow-up dacryocystography (DCG) after stent removal. Prognostic factors for patency after stent removal were evaluated by univariate and multivariate analyses for immediate patency and Kaplan-Meier survival analysis and multivariate analysis for maintained patency.

RESULTS

All stents were successfully removed under fluoroscopic or endoscopic guidance. After stent removal, 243 lacrimal systems (77%) showed immediate patency. The size of the lacrimal sac was the same (65% of cases), widened (2%), or contracted (33%) after stent removal. The shape of the lacrimal sac was normal in 30% and irregular in 70% of cases after stent removal. Seven-day follow-up DCG was obtained in 169 cases, and maintained patency of the lacrimal system was confirmed on 7-day follow-up DCG in 125 cases. Epiphora recurred in 70 cases (56%) during the mean 8-month follow-up period (range, 1-48 months). The mean maintained patency period after stent removal was 15.7 +/- 2.1 months. The maintained patency rates were 41% at 1 year, 31% at 2 years, and 14% at 4 years after stent removal. Multivariate analysis showed that the size of the lacrimal sac (P < .001) was the only factor affecting immediate and maintained patency after stent removal.

CONCLUSIONS

After stent removal in patients with nasolacrimal stent obstruction, the immediate patency rate was 77%; however, the rate of maintained patency decreased progressively with time. The major factor negatively affecting immediate and maintained patency after stent removal was contraction of the lacrimal sac at the time of stent removal.

Polyurethane stent obstruction as a cause of recurrent epiphora. Case report

SUMMARY

A Song's nasolacrimal duct stent was placed in a patient with epiphora due to primary nasolacrimal duct obstruction and the stent was kept for 32 months. Mitomycin C 0.02% eye drops four times a day were prescribed for four weeks following polyurethane stent placement procedure. No epiphora-related complaints occurred for thirty months after then the epiphora started. Nasolacrimal stent was removed from nasal cavity endoscopially and the tissues within the extruded stent were examined histopathologically. The patient's complaints were relieved following stent removal. Dacryocystogram revealed normal passage and a filling defect within the lacrimal sac. Macroscopic evaluation of the stent revealed a firm mass in the stent mushroom, causing complete obstruction. Pathological examination of the mass revealed chronic inflammation, increased connective tissue and vascular proliferation. Nasolacrimal polyurethane stents can be removed easily by nasal approach. Nasolacrimal passage may be left open temporarily after stent removal. The use of Mitomycin C drop is a novel approach in nasolacrimal stent placement cases. However, when the long-term results of endoscopic and external dacryocystorhinostomy are considered, further research is needed on the biocompatibility of stent material.

Nasolacrimal stents for the treatment of epiphora: technical problems and long-term results

PURPOSE

To evaluate the long-term effectiveness of nasolacrimal stents for the treatment of obstructive epiphora, and the complications related to the procedure.

METHODS

This study is a non-randomized prospective clinical trial. Eighty-five patients underwent fluoroscopally-guided placement of polyurethane stent in 86 lacrimal systems for the treatment of severe idiopathic obstructive epiphora. The sites of obstruction were: sac-duct junction (n = 65), sac (n = 10), and nasolacrimal duct (n = 11). The procedure was performed in an outpatient basis under local anesthesia. Patients were followed for a mean of 24 months (1-84) with clinical examinations and/or dacryocystography. Clinical success was defined as symptoms resolution or improvement, and the patency of the lacrimal system to irrigation.

RESULTS

Stent placement was technically successful in 76 (88.4%) eyes. Technical failures (11.6%) were caused by inability to pass the guide-wire through the lacrimal system. Immediate complications occurred in 19 (22%) eyes, were mild and included: self-limited epistaxis (7), mild palpebral hematoma (7), moderate pain (3), lacrimal puncta bleeding (1), palpebral emphysema (1), and false passage (1). Of the 76 inserted stents, 33 (43.4%) became occluded, and 43 (56.6%) remained patent after a mean of 24 months. Mean duration of stent patency was 38 months. Clinical success was achieved in 40 (52.6%) of the successfully implanted stents.

CONCLUSIONS

The procedure is well tolerated and can be performed on an outpatient basis. Patency decreases with follow-up, and, in the long-term, the success rate is inferior to that achieved by external dacryocystorhynostomy. However, it many be considered as a valid alternative to surgery in selected patients.

Clinicopathologic findings after nasolacrimal polyurethane stent implantations

PURPOSE

To evaluate the results of nasolacrimal polyurethane stent implantations for the treatment of primary acquired nasolacrimal duct obstruction, and to determine the effects of various surgical procedures, including stent removal, in subsequent nasolacrimal duct obstruction.

METHODS

This study included 15 patients who had nasolacrimal polyurethane implantations for the treatment of primary acquired nasolacrimal duct obstruction. Occluded stents were removed either by nasal endoscopy or during dacryocystorhinostomy (DCR). Cultures and biopsies were performed on the removed stents, and the results of the secondary DCR were analyzed for a 6-month follow-up period.

RESULTS

During stent removal surgery, various degrees of chronic inflammatory reaction and fibrous tissue formation were detected in the lacrimal sac and nasolacrimal duct. Formations of granuloma and fibrous tissue were found in 15 eyes, and culture-positive reaction were found in nine of the 15 eyes. Conventional dacryocystorhinostomy surgery was performed in nine of the 15 eyes and a silicone tube was located at the canaliculi. Subjective and objective outcome were favorable in 13 of the 15 eyes.

CONCLUSIONS

The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low. This may result from a chronic inflammatory reaction. Despite the low success rate of nasolacrimal polyurethane stent implantation, the success rate of endonasal DCR as a subsequent surgery is favorable.

Polyurethane stents for lacrimal duct stenoses: 5-year results

PURPOSE

To present 5-year results of polyurethane stent implantation for treatment of postsaccal lacrimal duct stenoses.

METHODS

Ninety-two consecutive patients admitted to our hospital for stent implantation between 1997 and 2001 were retrospectively analysed. The patients who were not re-treated in our clinic were asked by questionnaire about their satisfaction and complaints.

RESULTS

In 5 patients (5.4%) the implantation was not completed, 38 patients (41.3%) were re-treated due to relapsing epiphora during follow-up, and 11 stents (12.0%) were removed by dacryocystorhinostomy (DCR). Five stents (5.4%) were extracted transnasally. Four stents (4.3%) were removed in another hospital. Eighteen patients (19.6%) had relapsing epiphora but have not been re-treated so far. Forty-nine of 92 patients (53.3%) were not re-treated in our clinic and were interrogated by means of a questionnaire. Twenty-seven answered (55.1%), 8 did not answer (16.3%) and 14 patients (28.6%) did not receive the letter because they had moved away or died. Only 12 of the patients who answered the questionnaire had no or slight complaints (44.4%, or 18.5% of all treated patients).

CONCLUSIONS

The long-term success rate of polyurethane stent implantation is very low (18.5%).

Interventional radiology in the lacrimal drainage system

This article presents a review of the interventional radiological procedures in the lacrimal drainage system. Balloon dacryocystoplasty and nasolacrimal polyurethane stent placement are the main fluoroscopically guided interventions for the treatment of epiphora by recanalizing the obstructed LDS. These procedures can also be used for dacryolith removal and lacrimal sac abscess treatment.

Outcome of Patients with Nasolacrimal Polyurethane Stent Implantation: Do They Keep Tearing?

PURPOSE

To evaluate the results of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction and the effects of obstructed nasolacrimal stent on subsequent dacryocystorhinostomy (DCR).

METHODS

This study was designed as a nonrandomized, prospective clinical trial. Stent implantation was attempted in 53 obstructed lacrimal drainage systems of 47 patients. Stent placement was performed in a retrograde fashion through the external nare over a guide wire, which was introduced from the upper punctum. Occluded stents were removed either with nasal endoscopy or during DCR. External DCR surgery with silicone intubation was performed in cases with stent failure.

RESULTS

The mean follow-up period was 23.4 months. The success rate of stent implantation was 60.4%, 37.5%, and 31.2% at 6-, 12-, and 18-month follow-up, respectively. Stent obstruction developed in 33 eyes. Twenty underwent external DCR with silicone intubation. During DCR surgery, varying degrees of chronic inflammatory reaction were detected in the lacrimal sac and nasolacrimal duct. The mean follow-up period after DCR was 10.3 months. Epiphora was relieved with DCR in all but one eye.

CONCLUSIONS

The success rate of nasolacrimal polyurethane stent implantation for the treatment of primary acquired nasolacrimal duct obstruction is low and may induce inflammation and fibrous tissue formation. Although this may cause further difficulties in subsequent lacrimal surgery, epiphora could be relieved with meticulous technique.

Resolution of Epiphora with Nasolacrimal Stents: Results of Long-term Follow-up in a Multicenter Prospective Study

PURPOSE

To evaluate in a prospective, multicenter setting the long-term effectiveness of polyurethane stents in the percutaneous management of epiphora.

MATERIALS AND METHODS

Patients (n = 426; age range, 19-88 years, mean, 48; 91 men, 335 women) with severe epiphora had stents (470 eyes/496 stents) inserted to treat unilateral or bilateral and complete or partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 280 cases (59.5%) and chronic dacryocystitis in 190 (40.4%). The stent set designed by Song was used in all patients, and the original technique was slightly modified by us and conducted on an outpatient basis.

RESULTS

The initial technical success rate of stent placement was 95%. The average time of the procedure was 6 minutes (range, 3-70). Resolution of epiphora was complete in 452 eyes and partial in 18. On follow-up (mean, 24 months; range, 1 week to 67 months), 340 of 496 stents remained patent (68.5%). Segregating primary patency by year of follow-up, the rates were 75.6%, 68.4%, 64.8%, 60.1%, and 59.2% in the first, second, third, fourth, and the current (67 months) years, respectively. Minor complications such as moderate pain (21 cases), epistaxis (75 cases), palpebral edema and hematoma (31 cases), and headache (four cases) and two acute dacryocystitis events were recorded. Of the 156 obstructed stents, 114 were withdrawn, and 49 of these patients remained asymptomatic for a mean of 27 months (secondary patency, 31.4%). After stent removal, the sac configuration was unchanged in 93 (81.5%), contracted in 11 (9.6%), and widened in 10 (8.8%) cases.

CONCLUSIONS

The procedure is simple and safe, both in stent insertion and in withdrawal when occluded. The success rate was >75% in the short term and >55% in the long term. Although not totally without concerns, the technique is attractive for most patients who prefer not to undergo surgery or are unsuitable surgical candidates. Stent failure does not preclude subsequent treatment options and is an excellent first-line treatment of epiphora.

Treatment of Complete Obstruction of the Nasolacrimal System by Temporary Placement of Nasolacrimal Polyurethane Stents: Preliminary Results

AIM

To assess the efficacy of the temporary placement of polyurethane nasolacrimal stents as a treatment for complete post-saccal obstruction of the lacrimal apparatus.

MATERIALS AND METHODS

Polyurethane nasolacrimal stents were inserted under radiological guidance in nine patients with grade IV epiphora due to complete obstruction of the lacrimal system, at the junction of the lacrimal sac and duct (eight patients) or in the lacrimal duct (one patient). On average, the stents were removed 4 months (range: 3-6 months) after insertion. Dacryocystography was performed immediately before and after each stent was removed. Subsequently, periodic clinical and radiological examinations were performed until recurrence of the epiphora, at which point follow-up concluded.

RESULTS

All patients remained free of epiphora and clinical inflammation while the stents were in place, but re-obstruction of the lacrimal system occurred in all patients less than 2 months after the stents were removed. Adhesion of three stents to the lacrimal tract was observed upon removal. In seven cases the dacryocystography results at the end of follow-up revealed changes in the configuration of the lacrimal apparatus.

CONCLUSION

Based on our preliminary experience, temporary placement of polyurethane stents would not appear to be an efficacious therapeutic option for treating epiphora caused by post-saccal obstruction.