Outcomes of bicanalicular nasal stent inserted by sheath-guided dacryoendoscope in patients with lacrimal passage obstruction: a retrospective observational study

Abstract

Background: The dacryoendoscope is the only instrument that can observe the luminal side of the lacrimal passage with minimal invasiveness. It was developed to treat lacrimal passage obstructions by inserting a bicanalicular nasal stent with sheath-guided bicanalicular intubation (SG-BCI). The purpose of this study was to determine the outcomes of SG-BCI to treat lacrimal passage obstructions. In addition, to determine the effects of SG-BCI treatment on the quality of life.

Methods: This was a retrospective observational study of 128 patients (mean age 70.9 ± 11.0 years, range 28-93 years) diagnosed with a unilateral lacrimal passage obstruction. There were 73 patients with a nasolacrimal duct obstruction, 37 with a lacrimal canaliculus obstruction, 7 with a lacrimal punctum obstruction, and 11 with common lacrimal canaliculus and nasolacrimal duct obstructions. They were all treated with SG-BCI. The postoperative subjective outcomes were assessed by the answers to the Glasgow Benefit Inventory (GBI) questionnaire and to an ocular specific questionnaire on 6 symptoms including tearing, ocular discharges, swelling, pain, irritation, and blurred vision. The objective assessments were the surgical success rates and the patency at 6 months after the bicanalicular nasal stent was removed. The patients were divided into those with a pre-saccal obstruction, Group 1, and with a post-saccal obstruction, Group 2. The subjective and objective outcomes were compared between the two groups.

Results: One hundred twenty-four sides (96.9%) had a successful probing and intubation of the lacrimal passage obstruction by SG-BCI. Of the 124 sides, 110 sides (88.7%) retained the patency after the stent was removed for at least 6 months. The GBI total, general subscale, social support, and physical health scores were + 37.1 ± 29.0, + 41.5 ± 30.0, + 28.0 ± 39.4, and + 24.1 ± 37.7, respectively, postoperatively. All of the 6 ocular specific symptom scores improved significantly postoperatively. The postoperative score of tearing improved in Group 1 (P < 0.0001), while the postoperative scores of all symptoms improved significantly in Group 2.

Conclusions: The relatively high surgical success rates and positive GBI scores, and improved ocular symptom scores indicate that SG-BCI is a good minimally invasive method to treat lacrimal passage obstructions.

Keywords: Bicanalicular intubation; Dacryoendoscope; Glasgow benefit inventory; Lacrimal passage obstruction; Lacrimal stent.

Fig. 1

Photograph of a dacryoendoscope. The dacryoendoscope consists of a viewing and illuminating fiber optic bundle, and a water channel. The tip of the probe has an objective lens, light guide, and fluid nozzle. The outer diameter of the probe is 0.9 mm. The probe of the dacryoendoscope is bent at a 27-degree angle at 10 mm from its tip and has a 70-degree field of view

Fig. 2

Intraoperative view with a dacryoendoscope and nasal endoscope. The white fibrous lesion in the center is the occluded site (a). The tip of an 18-gauge catheter is placed on the occluded site (b). The occlusion is dislodged by sheath-guided endoscopic probing with the tip of the 18-gauge catheter. The gauze inserted in the inferior meatus can be seen (black arrow) (c). The view through the nasal endoscope at the inferior meatus. The right side is the inferior turbinate and left side is the inferior meatus. An 18-gauge catheter is seen passing through the opening of the nasolacrimal duct (d)

Fig. 3

Sheath-guided endoscopic probing and intubation technique for bicanalicular intubation. The bicanalicular nasal stent is inserted by the sheath-guided bicanalicular intubation technique. The dacryoendoscope loaded with an 18-gauge catheter reaches the obstruction site, the obstruction is released with the tip of the dacryoendoscope (a) or with the tip of an 18-gauge catheter (b). After the dacryoendoscope with the 18-gauge catheter is reached the inferior meatus, the 18-gauge catheter is left in the inferior meatus and the lacrimal duct and then the dacryoendoscope is drawn out of the lacrimal duct (c). After a bicanalicular nasal stent is connected with the 18-gauge catheter on the lacrimal punctum side (d), the catheter is withdrawn from the lacrimal duct through the inferior meatus (e), to be able to draw the bicanalicular nasal stent into the recanalized lacrimal duct (f). The same procedure is performed on the other lacrimal punctum, and then the lacrimal passage obstruction is completely intubated (g). Figure was adapted from Kamao (2020) [37]

Fig. 4

Ocular specific symptom scores. The horizontal line in the middle of each box indicates the median, while the top and bottom borders of the box mark the 75th and 25th percentiles, respectively. The whiskers above and below the box mark the minimum and maximum. “Pre” indicates preoperatively; and “post” indicates 6 months after the removal of the stent. Group 1, the pre-saccal obstruction group; Group 2, the post-saccal obstruction group. a Six ocular specific symptom scores for the preoperatively and 6 months after the removal of the stent. b The scores for Group 1. c. The scores for Group 2. Wilcoxon signed-rank tests were used to compare the pre- and the post-saccal groups. *P < 0.05; ** P < 0.01; *** P < 0.001; **** P < 0.0001

Fig. 5

Ocular specific symptom scores of pre-saccal and post-saccal obstruction for the preoperatively assessments. The horizontal line in the middle of each box indicates the median, while the top and bottom borders of the box mark the 75th and 25th percentiles, respectively. The whiskers above and below the box mark the minimum and maximum. Group 1, pre-saccal obstruction group; Group 2, post-saccal obstruction group. Mann-Whitney’s U tests were used to compare between Group 1 and 2. ** P < 0.01; **** P < 0.0001