Nasolacrimal duct reconstruction with the nasolacrimal duct prosthesis: an alternative to standard dacryocystorhinostomy.

For many years the standard surgical treatment for chronic dacryocystitis has been the edge-to-edge anastomosis of the lacrimal sac mucosa to nasal mucosa over the margins of a hole made through the lacrimal bone. Failures of this standard procedure have been attributed to many factors and complications frequently require reoperation. The procedure described in this paper was developed as a means of overcoming some of these difficulties. It provides a normal, gravity draining, nasolacrimal duct system without pooling and not requiring destruction of the lacrimal bone or alteration of normal anatomy. It consists of the implantation of a permanent indwelling nasolacrimal duct prosthesis (available from Concept, Inc., Clearwater, FL) from the base of the sac through the interosseous canal into the vault of the inferior nasal meatus. Because it does not involve bypassing the normal lacrimal drainage system, the technique is more simple and less traumatic. This method of reconstruction of the nasolacrimal duct has converted a major hour and a half procedure into a 15 minute operation. Because normal anatomic relationships are retained, the nasolacrimal duct prostheis gives reasonable assurance of permanent drainage and is recommended as a primary procedure of choice.