[Occlusion of the lacrimal puncta as treatment in obstruction of the nasolacrimal duct].
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Microscopic study of the human lacrimal ducts places the emphasis on the delicacy and complexity of the relations between the lacrimal muscle and the mobile lacrimal tubular system. The fixed part of the lacrimal ducts (nasolacrimal duct) contracts with the anterior pillar of the face, a fixed relation which inevitably exposes this part to lesions by shearing in the case of anterior maxillofacial trauma. The proximity of the nasolacrimal duct to the piriform cover is such that the duct may be approached surgically by trepanation of the anterior bony surface of the anterior pillar of the face.
Nasolacrimal duct obstruction is a common condition in patients who visit otolaryngologists and ophtalmologists. The patients complain of epiphora and blurred vision. Reconstruction of lacrimal drainage provides great improvement in a patient's quality of life. On the base of the world literature and the own experience, several surgical techniques of the lacrimal system are presented and analyzed regarding indications and results: dacryocystorhinostomy (DCR), canaliculodacryocystorhinostomy (CanDCR), con-junctivodacryocystorhinostomy (ConDCR) and intubation. External DCR usually involves extensive removal of bone at the lacrimal fossa and hence risks disruption of the lacrimal pump mechanism. The development of endonasal microsurgery (endoscope, microscope) have awakened interest in an internal DCR in treatment nasolacrimal obstruction. Endonasal microscopic dacryocystorhinostomy become an important alternative to the classical external DCR. This method preserves intact the normal function of the lacrimal pump, yields cosmetic excellent results and allows at the same time management of the concomitant sino-nasal pathology.