Inferior meatus endoscopy and directed treatment for epiphora: Early experience with a novel approach

Abstract

IM endoscopy identified pathology in most constant epiphora patients in this study. Pathology at the distal NL system portends a better outcome, whereas extension to the proximal NL duct had poorer outcome.

Avoiding dacryocystorhinostomy in cases of epiphora caused by inferior meatus obstruction

“…Previously published series suggest that nasal mucosa hypertrophy and septal deviation are common causes for NLDO [5,6]. While these were common findings in our cases series too (37.5%), we have found that it often coexists with other pathologies of the IM.…”

“…Three cysts, three obstructive membranes, two severe septal deviations, two concheal hypertrophies, and two dacryoliths. To date, no large series reported dacryoliths and membranes obstructing the IM and previous reports of other IM pathologies were confined to case reports [3][4][5][6][7][8].…”

“…Correct diagnosis of the obstruction site and its nature is essential for choosing a treatment plan and a surgical approach [2]. Recent reports suggest that obstructions of Hasner's valve (inferior meatus, IM) are significantly more common in adults than previously appreciated [3][4][5][6]. In this paper, we will describe a wide variety of pathologies of the IM that represent our experience and offer a diagnostic approach for future cases.…”

Dacryocele in an adult presenting as facial cellulitis

“…Inferior meatal surgeries to overcome distal nasolacrimal duct obstructions have also been described 7,8 .…”

“…Studies have shown that inferior meatus endoscopy with directed treatment results in long-term improvement of epiphora in 93% cases when performed for distal nasolacrimal duct obstructions 8 . The standard treatment of nasolacrimal duct obstruction is dacryocystorhinostomy (DCR) through either an external or endoscopic approach but if distal nasolacrimal duct orifice obstruction is the cause of the epiphora, less invasive procedures can be attempted.…”