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Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction

Our Experience

Goel, Ruchi M.S.*; Nagpal, Smriti M.S.*; Kumar, Sushil M.D.*; Meher, Ravi M.S.; Kamal, Saurabh M.S.*; Garg, Sonam M.S.*

Ophthalmic Plastic & Reconstructive Surgery: November/December 2017 - Volume 33 - Issue 6 - p 408–412
doi: 10.1097/IOP.0000000000000802
Original Investigations

Purpose: To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up.

Methods: A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley’s nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p < 0.05).

Results: The mean age of the patients was 35.3 ± 15.89 years, with 23 male and 37 female patients, the 2 groups having a similar male:female ratio. An overall success rate of 90% was achieved at the end of 1 year with no statistically significant difference between the groups. Postoperative complications like tube displacement and punctal, canalicular injury were more in the intubated group. The average osteotomy size was 8.06 ± 5.4 mm2 at the end of 1 year.

Conclusions: Transcanalicular laser-assisted dacryocysto rhinostomy, with endonasal augmentation, is a scarless, effective, daycare procedure, for treatment of primary acquired nasolacrimal duct obstruction with no additional advantage offered by silicone intubation.

Transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation utilizes a judicious combination of laser energy and instrument enlargement, to create a larger ostium, with lesser complications, and with no additional benefit offered by silicone intubation.

*Department of Ophthalmology, Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), Maharaja Ranjeet Singh Marg; and Department of Otolaryngorhinology, Lok Nayak Hospital (Associated with Maulana Azad Medical College), Jawahar Lal Nehru Marg, New Delhi, India

Accepted for publication August 30, 2016.

Presented at the BOPSS Annual Meeting at Waterfront Hall, Belfast, United Kingdom, June 17-19, 2015.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Dr. Smriti Nagpal, M.S., Guru Nanak Eye Centre (Associated with Maulana Azad Medical College), Maharaja Ranjeet Singh Marg, New Delhi-110002, India. E-mail:

© 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.