Nonsurgical placement of a nasolacrimal polyurethane stent: Long-term effectiveness

PURPOSE: To evaluate the longterm effectiveness of a polyurethane stent in the treatment of obstruction of the lacrimal sac and the nasolacrimal duct. MATERIALS AND METHODS: Fluoroscopically guided placement of a polyurethane nasolacrimal stent was evaluated in 283 obstructed lacrimal systems of 236 patients, with a follow-up period of more than 1 year (range, 52-134 weeks). The obstruction was at the junction between the lacrimal sac and the nasolacrimal duct in 192 systems, at the lacrimal sac in 52, and at the nasolacrimal duct in 39. The causes of obstruction were traumatic in 34 and idiopathic in 249 systems. RESULTS: Stent placement was technically successful in 270 systems (95%). At 7 days after stent placement, 235 (87%) of the 270 systems with successful placement demonstrated complete resolution of epiphora, 27 (10%) had partial resolution, and the remaining eight (3%) had no resolution. There was recurrence in 81 systems due to obstruction of the stent (n = 77) or obstruction of the common canaliculus (n = 4). The recurrence rate was much higher in the systems with obstruction at the lacrimal sac (64%) than in the systems with obstruction at the junction (26%) between the lacrimal sac and nasolacrimal duct or at the nasolacrimal duct (15%). CONCLUSION: Stent placement in the obstructed lacrimal system below the junction between the lacrimal sac and the nasolacrimal duct is valuable as an initial therapy.