Holmium laser canaliculoplasty.

Thirty canaliculi of 18 patients with complete or nearly complete canalicular obstruction were subjected to laser canaliculoplasty as a substitute for the standard Jones-type bypass conduct. Etiologies for the obstruction included congenital lacrimal system atresia, eyelid trauma, scarring following previous lacrimal surgery, and chronic inflammatory fibrosis. The procedure utilized a holmium laser delivered via a 1,000 mu optical fiber to cut a 1-mm channel from the punctum into the lacrimal sac. In nine eyes, this procedure was combined with a surgical dacryocystorhinostomy (DCR) for concurrent lower nasolacrimal duct obstruction. Silicone stents were left in place for 6 months postoperatively. Follow-up data were available for 28 canaliculi of 17 patients. Moderate or better improvement in symptomatic epiphora and evidence of canalicular patency to drainage was seen in 16 of 28 (57%) treated canaliculi, and significant improvement was recorded in 12 of 28 (43%). Although these figures are lower than those obtainable after repair of small areas of focal canalicular stenosis or obstruction, the procedure is superior to any previous attempts at reconstruction of extensive obstructions, short of placement of a Jones tube. When successful, this procedure offers re-establishment of a near normal physiologic system, and avoids the complications of and patient dissatisfaction associated with a Jones tube.