title: A prospective outcome study of membranous and solid distal common canalicular obstructions.
abstract: OBJECTIVE
  To prospectively evaluate the surgical outcomes of membranous and solid distal common canalicular obstructions (CCOs) following endoscopic dacryocystorhinostomy (EnDCR) and lacrimal intubation combined with either membranotomy or trephination.
  
  
  METHODS
  This was a prospective, non-randomized, consecutive interventional case series. Inclusion criteria included patients undergoing EnDCR with evidence of a membranous block or more solid obstruction of the distal common canaliculus, treated with membranotomy or canalicular trephination. Complete CCO was confirmed pre-operatively using dacryocystography and dacryoscintigraphy. All patients received bicanalicular intubation for 3 months with a minimum follow-up of 12 months. Functional and anatomical success was assessed at 4 weeks, 3 months, and 12 months following surgery. Functional success was defined as subjective improvement of epiphora and anatomical success as the presence of a patent ostium and a positive dye test on nasal endoscopy.
  
  
  RESULTS
  Twenty-nine patients were included in the study with a mean age of 58 years. Twenty-one patients (72%) received a membranotomy and eight (28%) required trephination. At 12 months, the functional and anatomical success rate in the membranotomy group was 90% (19/21) and 100% (21/21), respectively, and in trephination group the functional and anatomical success rate was 63% (5/8). There were no intra-operative or lacrimal stent-related complications.
  
  
  CONCLUSIONS
  Identifying and excising distal CCOs in association with EnDCR and lacrimal intubation is associated with a high degree of functional (83%) and anatomical (90%) success. The success of membranous obstructions appear be superior to outcomes for solid obstructions of the distal common canaliculus that require trephination.
authors: Adnexal Service, Moorfields Eye Hospital, London, UK.|Department of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors: P N
authors: PN
authors: Shams
authors: Oculoplastic Service, Niagara Health System, Fort Erie, Ontario, Canada.
authors: A
authors: A
authors: Pirbhai
authors: Department of Ophthalmology and Visual Sciences, South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia.
authors: D
authors: D
authors: Selva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods; D007767:Lacrimal Duct Obstruction / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008566:Membranes / Q000601:surgery; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult