Treatment of lacrimal stenoses obstructions with interventional radiology: immediate and 5-year follow-up results

This study was undertaken to evaluate the effectiveness of the Song stent in patients with nasolacrimal duct obstruction. Between 2003 and 2007, we treated 76 consecutive nasolacrimal obstructions in 73 patients (mean age 56 years; range 19-81) with implantation of polyurethane stents. Indications were epiphora in 46 patients, dacryocystitis in 18 and recurrent conjunctivitis in three. Average follow-up was 1 year (3 months to 5 years). Technical success was achieved in 73 procedures (96%). Complications included pain in three cases, eyelid inflammation in four cases and severe bleeding in one case. Postprocedural mucocele was observed in five patients. Mean time without symptoms was 31 weeks. There were 24 cases of stent obstruction: 15 were treated with high-pressure 5% N-acetyl-cysteine and saline flush, achieving resolution in two cases; in three cases, attempts to recanalise the obstruction with a guidewire failed. The occluded stents were rsemoved in 22 patients: seven remained asymptomatic, 15 had recurrence of epiphora, nine received a new stent after dacryocystography and six underwent dacryocystorhinostomy. Advantages of the procedure include the lack of anatomical alterations to the lacrimal ducts and a low short-term complication rate, whereas limitations include restricted duration of stent patency. The pathophysiological causes of stent obstruction should be clarified in order to relate them to stent morphology.