Lacrimal drainage system obstruction: management and results obtained in 70 patients.

Causes and types of acquired obstruction of the lacrimal drainage system are discussed in 70 patients, as well as the results of their surgical treatment. Obstruction of the lacrimal drainage pathway, according to frequency, was due to: trauma (mainly naso-orbital and LeFort II fractures), post-inflammatory stenosis of the nasolacrimal duct, tumours and latrogenic injuries of the naso-lacrimal drainage system often following Caldwell-Luc operations of the maxillary sinus. The ages of patients ranged from 3-70 years. Canalicular obstruction was diagnosed in 9 (12.9%), obstruction of the lacrimal sac in 2 (2.8%), while obstruction of the naso-lacrimal duct in 50 (71.4%) patients, including 3 bilaterally. And in 9 (12.9%) patients, injury to the lacrimal system following excision of tumours of the eyelids and the medial canthal region occurred. In patients with canalicular obstruction intubation of the canaliculi was carried out and both ends of the drain were inserted into the nasal cavity for 6 months via a dacryocystorhinostomy. Total recovery was obtained in 44.5%. In lacrimal sac and nasolacrimal duct obstruction Dupuy-Dutemp's dacryocystorhinostomy was performed and 90.4% of the patients recovered. When fibrosis or extensive damage of the lacrimal sac had occurred, wide anastomosis with the nasal duct was indicated. After tumour excision, the lacrimal pathways were reconstructed by conjunctivo-rhinostomy, conjunctivo-sinusostomy or conjunctivo-dacryocystorhinostomy. In 40% of the patients who underwent conjunctivo-dacryocystorhinostomy a successful outcome ensued.