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Abstract
Retrograde balloon dilatation under X-ray visualization presents a new way of treatment of incomplete postsaccal stenosis. These stenoses in the area of the nasolacrimal duct in adults exhibit a common factor of favorable circumstances in the prestenotic area for recurring inflammations. The treatment of these disorders was-up to now-limited to either a conservative therapy to control inflammation or surgically invasive measures. The new method of treatment enables us to dilate incomplete stenoses without any alteration of skin and without bleeding.
After different functional tests a digital dacryocystography is performed using a computer controlled X-ray unit with a C-arc coupled to an image intensifying TV-system. This gives the indication for balloon dilatation. A balloon catheter set originaly designed for the PTCA (percutaneous, transluminal coronary angioplasty) is used. After placing the guiding wire via canaliculi and lacrimal sac into the nose antegradely the balloon catheter is retrogradely positioned at the site of stenosis under X-ray control. The dilatation is performed by means of high pressure and followed by a monocanalicular silicone intubation to prevent restenosis.
Eight patients with incomplete postsaccal lacrimal stenosis have been successfully treated by using this method. So far there has been no recurrence of acute dacryocystitis in any of the patients.
An exact diagnosis using various testing methods, including a digital dacryocystography for detailed localization and documentation of any pathological changes, is decisive for success. Only in cases of incomplete, postsaccal stenosis is retrograde balloon dilatation of the distal nasolacrimal duct indicated.
Initial results give rise to the hope that this minimally invasive technique represents a new alternative in the treatment of incomplete postsaccal lacrimal stenosis.