Dacryoendoscopy and laser dacryoplasty: technique and results

In a bicentrical study in the eye clinic of Darmstadt and the eye clinic of the St. Josef Hospital Hagen 261 dacryoendoscopies were performed until February 1997. In 261 dacryoendoscopies (143 women, 93 men and 25 children, the average age was 46.6 years). In dependence of the assessment of the mucosa conditions intraoperatively in all 261 cases the planed operative strategy was checked and if needed changed. After surgical interventions of the lacrimal system 70 cases of dacryocystorhinostomia externa were seen 138 cases of intubation of the lacrimal drainage system and 53 cases of laserdacryoplastic. Intubation of the lacrimal system was always performed after laserdacryoplastic and after a patency was produced (average age 58.3 years). Suitable indications for a laserdacryoplastic are: circumscribed stenosis of the distal saccus, point-sized stenosis of the canaliculus, membranous restenosis after dacryocystorhinostomia externa. The method shows no important rate of intraoperative complications, only in one case there was intraoperatively a protrusion bulbi and a haematoma of the eyelid, which postoperatively eased fastly away. The postoperative convalescence is in comparence to conventional surgical interventions of the lacrimal drainage system enormously shortened. The follow-up after 3 months showed a subjective improvement of epiphora in more than 75% of the patients, the success of this intervention therefore could be compared with conventional surgical methods of the lacrimal drainage system. The dacryoendoscopy is a new important diagnostic development, which shows with help of better developed endoscopy-systems compared to previous systems a much better quality of the image and is therefore a valuable diagnostic help. Due to the check of the preoperative indication it is intraoperatively possible to confirm or, if needed, to change the indication after dacryoendoscopy. The laserdacryoplastic is an important new therapeutical development of the dacryoendoscopy and shows in suitable indications a comparable success-rate of conventional surgical interventions of the lacrimal drainage system. Therefore the possibility exists to carry out minimal invasive interventions of the lacrimal drainage.