Abstract
Purpose :
Canalicular laceration usually accompanies eyelid laceration. The orbicularis and medial canthal ligament may be injured at the same time, which leads to defective lacrimal pump function. After canalicular anastomosis and eyelid tightening, most patients can achieve a patent lacrimal system and symptom relief, while few patients may still suffer from functional epiphora. Endoscopic dacryocystorhinostomy (DCR) was considered to reduce the lacrimal drainage resistance and meanwhile preserve lacrimal pump function. We investigate the outcome of endoscopic DCR in patients with functional epiphora after canalicular and eyelid laceration repair.
Methods :
Retrospective chart review. All injured patients received primary re-approximation of the canalicus and orbicularis/medial canthal tendon repair. After at least one month, if the patient still complained of tearing, endoscopic DCR with bicanalicular silicone intubation were performed. Patients with re-stenosis of canaliculus or ocular surface disease were excluded. A combination of Munk score and Lac-Q social impact score were used to assess the outcome.
Results :
From January 2019 to December 2021, there were 34 patients who received canalicular and eyelid laceration repair. 6 patients received secondary endoscopic DCR due to persistent epiphora after the repair. One had both and the others had lower canalicular laceration. All patients achieved symptom relief immediately after operation. At the last follow-up, all patients were satisfied with the results. Munk score improved from grade 4 to 2 in 2 patients, from grade 4 to 1 in 4 patients). Lac-Q social impact score improved from 5 points to 0 in 3 patients, From 5 to 1 in 1 patient, from 5 to 2 in 2 patients). No recurrence or postoperative complication was found during the follow-up period (Range: 6-17 months, mean: 9.8 months).
Conclusions :
Functional epiphora in patients with canalicular laceration can be managed with endoscopic DCR. After successful repair and patent on lacrimal irrigation, there may still be slightly increased outflow resistance. Combining the slightly reduced pump function due to lid laceration, this can lead to postoperative epiphora. Endoscopic DCR decreases lacrimal drainage resistance and affect the lacrimal pump function minimally. There was no significant complication in this study. More case studies are needed to evaluate the outcome.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.