Acquired nasolacrimal duct obstructions secondary to naso-orbito-ethmoidal fractures: patterns and outcomes

Abstract

Purpose: This study reports a series of 14 consecutive patients of nasolacrimal duct obstruction secondary to naso-orbito-ethmoid fractures (NOE), their presentations, surgical interventions, and outcomes.

Methods: Fourteen consecutive patients presenting with secondary acquired nasolacrimal duct obstructions following naso-orbito-ethmoid fractures were included in a retrospective, noncomparative case series. Medical records were reviewed for demographic data, mode of trauma, types of NOE fractures, type of fracture repair, symptoms at presentation, duration of symptoms, areas of lacrimal obstructions, surgical interventions, lengths of follow up, and outcomes. Success was defined as both anatomical patency of the lacrimal passages and resolution of symptoms.

Results: The mean age at presentation was 26.4 years (range: 4-46). The most common mode of trauma was a road traffic accident (71.4%), and the most common type of fracture was NOE type II (64.2%). The majority of the fractures (71.4%) were repaired by open reduction and internal fixation. All patients presented with epiphora, and 50% of them also presented with a swelling below the medial canthus. The mean duration of symptoms were 19.5 months (range: 1-48). All patients underwent an external DCR with mitomycin C and silicone intubation. All stents were removed at 12 weeks following surgery. The mean follow up after stent removal was 6 months (range 3-24 months) with a minimum follow up of 3 months. At the last follow up, the success rate was 92.8%. There was one failure, which was due to cicatricial closure of the ostium.

Conclusion: External dacryocystorhinostomy with Mitomycin-C and intubation is effective in treatment of acquired nasolacrimal duct obstructions following NOE fractures. A delayed dacryocystorhinostomy did not appear to influence the outcomes.