Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquired partial nasolacrimal duct obstruction in adults

AIM: To report the outcomes of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in patients with acquired partial nasolacrimal duct obstructions in adults. METHODS: Retrospective case series, included 21 eyes with partially obstructed nasolacrimal ducts of 12 patients. All the 21 ducts were initially probed and the probe confirmed with an endoscope in the inferior meatus. After confirming the presence of probe in the inferior meatus, a 3 mm balloon was used for dilating the distal and proximal portions of nasolacrimal duct, followed by stenting of ducts with Crawford tubes. Main outcome measures were anatomical patency of the passage and resolution of epiphora. RESULTS: Of the 12 patients, 9 had bilateral and 3 had unilateral acquired partial nasolacrimal duct obstructions. All the patients underwent bicanalicular stenting under endoscopic guidance which were retained for a period of 12 weeks. A minimum follow up of 6 months following stent removal was considered for final analysis. 15 of the 21 ducts (71%) were freely patent on irrigation but 13 of the 21 reported improvement of epiphora. Two nasolacrimal ducts showed similar partial regurgitation and partial patency on syringing as before with no improvement of symptoms. Four nasolacrimal ducts were completely obstructed with complete regurgitation of fluid on syringing with worsening of the epiphora. Two eyes persisted with symptoms of epiphora despite patent nasolacrimal duct with grade 2 dye retention on dye disappearance test. CONCLUSIONS: 3 mm balloon dacryoplasty is an alternative and safe way to manage partial nasolacrimal duct obstructions with an anatomical success in 71% and functional success in 62% of the patients. Further studies with a large sample size and longer follow-up are required to ascertain the long term benefits.