[Dacryocystostomy and microsurgical lacrimal sac reconstruction in dacryolithiasis].
BACKGROUND
The incidence of dacryoliths ranges between 8 and 14% of patients undergoing a dacryocystorhinostomy. Lacrimal duct stenoses with dacryoliths can be managed either by surgery or minimally invasive techniques. We present two patients who underwent removal of dacryoliths by dacryocystotomy and microsurgical reconstruction without osteotomy.


METHODS
Case report 1: A 47-year-old male patient presented with chronic epiphora. The dacryocystogram revealed a filling defect in the dilated lacrimal sac. Case report 2: A 22-year-old female patient suffered from a hemorrhagic right-sided dacryocystitis. Two years previously the patient had undergone lacrimal endoscopy with silicone intubation for 3 months. Preoperative dacryocystography showed an obliteration of the superior portion of the lacrimal sac. In both patients, we performed the extraction of the dacryolith by dacryocystotomy followed by silicone tube intubation of the lacrimal system for 3 months. Both patients with a follow-up of 24 and 29 months, respectively, showed good clinical results and patent nasolacrimal pathways on digital dacryocystography.


RESULTS
Methods to extract dacryoliths include minimally invasive techniques such as nonsurgical radiologic or endoscopic removal during dacryoplasty or surgical approaches such as external or endonasal dacryocystorhinostomy.


CONCLUSIONS
Dacryocystotomy with primary microsurgical lacrimal sac reconstruction combined with silicone intubation is an alternative surgical procedure to remove dacryoliths. An osteotomy is not always required.
Guthoff
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Universitäts-Augenklinik Würzburg, Josef-Schneider-Strasse 11, 97080 Würzburg. r.guthoff@mail.uni-wuerzburg.de
Lieb
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WE
D000328:Adult; D002137:Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000000981:diagnostic imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011859:Radiography; D013382:Subtraction Technique