Injury to the lacrimal apparatus after endoscopic sinus surgery: surgical implications from active transport dacryocystography.

In order to evaluate the lacrimal drainage system injury after functional endoscopic sinus surgery, surgical records and postoperative active transport dacryocystography imaging of 31 patients were analyzed. Presence of the lacrimal bone dehiscence and no passage of the contrast material into the inferior meatus were noted as the signs of injury to the lacrimal canal on active transport dacryocystography. Bony dehiscence was detected in 53.2% of the operated sides but 20% of the nonoperated sides. No passage of the contrast material into the inferior meatus was observed in 14.9% of the operated sides. There were no cases of epiphora postoperatively. The lacrimal drainage system injury was more frequently observed on the left sides operated. We conclude that lacrimal drainage system injury might occur in various extents during functional endoscopic sinus surgery. However, it does not necessarily result in postoperative epiphora. Performing the middle meatal antrostomy in posteroinferior direction, and uncinectomy with backbiting forceps or a shaver might help in reducing the lacrimal injury. Active transport dacryocystography can be adopted as an alternative diagnostic tool in detection of the lacrimal injury.