Nasolacrimal Stents for the Treatment of Epiphora: Technical Problems and Long-Term Results

• Published in: Orbit (Amsterdam) 2006-01, Vol.25 (2), p.75-81
• Main Authors: Pinilla, Inmaculada, Fernández-Prieto, Andrés F., Asencio, Mónica, Arbizu, Alvaro, Peláez, Natalia, Frutos, Remedios
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Epiphora; Female; Humans; interventional procedures; lacrimal duct; Lacrimal Duct Obstruction - therapy; Male; Middle Aged; Nasolacrimal Duct; Polyurethanes; Radiography, Interventional; Stents - adverse effects; stents and prostheses
• ISSN: 0167-6830; 1744-5108
• DOI: 10.1080/01676830500499232

Purpose: To evaluate the long-term effectiveness of nasolacrimal stents for the treatment of obstructive epiphora, and the complications related to the procedure. Methods: This study is a non-randomized prospective clinical trial. Eighty-five patients underwent fluoroscopally-guided placement of polyurethane stent in 86 lacrimal systems for the treatment of severe idiopathic obstructive epiphora. The sites of obstruction were: sac-duct junction (n = 65), sac (n = 10), and nasolacrimal duct (n = 11). The procedure was performed in an outpatient basis under local anesthesia. Patients were followed for a mean of 24 months (1-84) with clinical examinations and/or dacryocystography. Clinical success was defined as symptoms resolution or improvement, and the patency of the lacrimal system to irrigation. Results: Stent placement was technically successful in 76 (88.4%) eyes. Technical failures (11.6%) were caused by inability to pass the guide-wire through the lacrimal system. Immediate complications occurred in 19 (22%) eyes, were mild and included: self-limited epistaxis (7), mild palpebral hematoma (7), moderate pain (3), lacrimal puncta bleeding (1), palpebral emphysema (1), and false passage (1). Of the 76 inserted stents, 33 (43.4%) became occluded, and 43 (56.6%) remained patent after a mean of 24 months. Mean duration of stent patency was 38 months. Clinical success was achieved in 40 (52.6%) of the successfully implanted stents. Conclusions: The procedure is well tolerated and can be performed on an outpatient basis. Patency decreases with follow-up, and, in the long-term, the success rate is inferior to that achieved by external dacryocystorhynostomy. However, it many be considered as a valid alternative to surgery in selected patients.