[Endoscopically controlled surgery with the micro-drill and intubation of the lacrimal ducts].

PURPOSE: Operative procedures to manage lacrimal outflow obstruction were made traditionally without endoscopic assistance. For dacryoendoscopy we previously used a 0.5-mm endoscope with a special wash cannula. We now use the microendoscope Vitroptic T for dacryoendoscopy and for endoscopically controlled 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 microoptic and a channel for a microdrill. We report on our initial experiences and on the results of eight patients with stenosis of the lacrimal outflow system who were treated with an endoscopic microdrill and silicone tubing. One 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 situations during dacryoendoscopy are demonstrated. The Vitroptic T allows dacryoendoscopy and endoscopically controlled surgery of the lacrimal drainage system. Three months after surgery in six patients (75%) the lacrimal outflow system 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 lacrimal drainage system enables atraumatic and minimally invasive surgery. The Vitroptik T with the microdrill allows endoscopically controlled microsurgery. Possible indications for the microdrill are punctual stenosis and re-stenosis after external DCR.