Endoscopic Management of Permanent Lacrimal Duct Injury After Sinus Surgery.

BACKGROUND

This case series reports on permanent lacrimal duct injuries (LDI) subsequent to sinus surgery and their management by endoscopic dacryocystorhinostomy (En-DCR).

METHODS

We reviewed medical records of patients presenting with epiphora postsinus surgery from January 2018 to May 2023. Data were analyzed for demographics, results of diagnostic irrigation and probing, findings from computed tomography dacryocystography (CT-DCG), En-DCR interventions, and outcomes.

RESULTS

The study included 31 patients with permanent epiphora and LDI. The average interval from sinus surgery to the onset of epiphora was 5.58±6.72 days (range: 1 to 30 d) and from sinus surgery to En-DCR surgery was 16.19±10.50 months (range: 4 to 36 mo). Diagnostic tests identified complete lacrimal duct obstruction in 29 (93.55%) patients and partial obstruction in 2 (6.45%) patients. CT-DCG revealed a nasolacrimal duct (NLD) bone defect and dense residual contrast in the dacryocyst in all cases, with obstructions noted at the NLD-dacryocyst junction in 4 (12.90%) patients and at the NLD in 27 (87.10%) patients. All patients underwent En-DCR, achieving an anatomic success rate of 90.32% (28/31) and a functional success rate of 80.65% (25/31) over an average follow-up of 16.10±6.56 months (range: 9 to 36 mo).

CONCLUSION

Permanent LDI represents a significant complication of sinus surgery. En-DCR offers a viable and highly effective treatment option for this condition.