CardioVascular and Interventional Radiology

, Volume 34, Issue 1, pp 124–131 | Cite as

Treating Epiphora in Adults With the Wilhelm Plastic Nasolacrimal Stent: Mid-Term Results of a Prospective Study

  • Juan J. Ciampi
  • Carlos Lanciego
  • Sofia Navarro
  • Rafael Cuena
  • Javier Velasco
  • Miguel Perea
  • Lorenzo García-García
Clinical Investigation


The objective of the present study was to evaluate, in a prospective, single-center study, the effectiveness of the Wilhelm-type stent used in interventional radiology for the management of epiphora. Patients (n = 104; mean age 64 [range 25–88]; 33 male and 71 female) with severe epiphora had the stents inserted (135 stents in 115 eyes) to treat obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 83 cases, chronic dacryocystitis in 31, cases and postsurgical status in 1 case. The overall technical success rate of stent placement was near 94%. Resolution of epiphora was complete in 105 cases and partial in 3 cases. During a mean 13-month follow-up (range 1 week to 28 months), the median duration of primary patency was 11 months, and the percentage of patency at 6 months was 60.8%, at 1 year was 39.6%, and at 2 years was 25%. Stents malfunctioned in 54 cases, and all were easily withdrawn except in 1 case. Of these 27 cases, patency recovered spontaneously in 9 and by way of a second stent in 18. Secondary patency was 50%. Factors presdisposing to lower primary patency are inflammatory etiology and location of the obstruction. The benefit of stent deployment is clear with respect to the resolution of epiphora in candidate patients for percutaneous treatment. Technical and/or design improvements would be welcomed.


Lacrimal system treatment Lacrimal duct and sac obstruction Interventional procedures Stent Prostheses 



We thank the team of doctors and nurses of the Interventional Radiology Unit of the Hospital Virgen de la Salud (Toledo, Spain) as well as the ophthalmologists and nursing personnel of the outpatient clinics of the Hospital Virgen del Prado (Talavera-España, Spain) and the Hospital de Toledo (Spain). Editorial assistance was given Peter R. Turner of t-SciMed (Reus, Spain).


  1. 1.
    Becker BB, Berry FD (1989) Balloon catheter dilatation in lacrimal surgery. Ophthalmic Surg 20:193–198PubMedGoogle Scholar
  2. 2.
    Massaro BM, Gonnering RS, Harris GJ (1990) Endonasal laser dacryocystorhinostomy: a new approach to nasolacrimal duct obstruction. Arch Ophthalmol 108:1172–1176PubMedGoogle Scholar
  3. 3.
    Yacizi B, Yacizi Z, Parlak M (2001) Treatment of nasolacrimal duct obstruction in adults with polyurethane stent. Am J Ophthalmol 131:37–43CrossRefGoogle Scholar
  4. 4.
    Lee JM, Song HY, Han YM et al (1994) Balloon dacryocystoplasty: results in the treatment of complete and partial obstructions of the nasolacrimal system. Radiology 192:503–508PubMedGoogle Scholar
  5. 5.
    Yacizi Z, Yacizi B, Parlak M et al (1999) Treatment of obstructive epiphora in adults by balloon dacryocystoplasty. Br J Ophthalmol 83:692–696CrossRefGoogle Scholar
  6. 6.
    Song HY, Jin YH, Kim JH et al (1994) Nasolacrimal duct obstruction treated nonsurgically with use of plastic stents. Radiology 190:535–539PubMedGoogle Scholar
  7. 7.
    Kang SG, Song HY, Lee DH et al (2002) Nonsurgically placed nasolacrimal stents for epiphora: long-term results and factors favoring stent patency. J Vasc Intervent Radiol 13:293–300CrossRefGoogle Scholar
  8. 8.
    Lee DH, Song HY, Ahn S et al (2001) Balloon dacryocystoplasty: results and factors influencing outcome in 350 patients. J Vasc Intervent Radiol 12:500–506CrossRefGoogle Scholar
  9. 9.
    Perena MF, Castillo J, Medrano J et al (2001) Nasolacrimal polyurethane stent placement: preliminary results. Eur J Ophthalmol 11:25–30PubMedGoogle Scholar
  10. 10.
    Pinto I, Paul L, Grande C et al (2001) Nasolacrimal polyurethane stent placement for epiphora: technical long-term results. J Vasc Intervent Radiol 12:67–71CrossRefGoogle Scholar
  11. 11.
    Song HY, Lee DH, Ahn H et al (2002) Intervention in the lacrimal drainage system. Cardiovasc Intervent Radiol 25:165–170CrossRefPubMedGoogle Scholar
  12. 12.
    Lanciego C, Toledano N, De Miguel S et al (2003) Resolution of epiphora with nasolacrimal stents: results of long-term follow-up in a multicenter prospective study. J Vasc Intervent Radiol 14:1417–1425Google Scholar
  13. 13.
    Lanciego C, De Miguel S, Padilla M, Perea M, Rodriguez-Merlo R, García García L (2006) Nasolacrimal stenting: towards improving outcomes with a simple modification of the Song stent. Cardiovasc Intervent Radiol 29:586–594CrossRefPubMedGoogle Scholar
  14. 14.
    Wilhelm KE, Loeffler K, Urbach H et al (2002) Complete tear duct obstruction: Treatment with lacrimal polyurethane stent implantation [abstract]. Cardiovasc Intervent Radiol Soc Europe 25(Suppl 2 CIRSE):S149Google Scholar
  15. 15.
    Wilhelm KE, Grabolle B, Urbach H et al (2006) Evaluation of polyurethane nasolacrimal duct stents: in vivo studies in New Zealand rabbits. Cardiovasc Intervent Radiol 29:846–853CrossRefPubMedGoogle Scholar
  16. 16.
    Lanciego C, Navarro S, Velasco J, Perea M et al (2009) Randomized comparison of nasolacrimal cryoplasty versus plastic lacrimal stenting in the management of epiphora in adults. J Vasc Interv Radiol 20:1588–1596CrossRefPubMedGoogle Scholar
  17. 17.
    Munk PL, Lin DTC, Morris DC (1990) Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology 177:687–690PubMedGoogle Scholar
  18. 18.
    Song HY, Lee DH, Ahn H et al (1998) Lacrimal system obstruction treated with lacrimal polyurethane stents: outcome of removal of occluded stents. Radiology 208:689–694PubMedGoogle Scholar
  19. 19.
    Hartikainen J, Grenman R, Puukha P et al (1988) Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology 105:1106–1113CrossRefGoogle Scholar
  20. 20.
    Moore WN, Bentley CR, Olver JM (2002) Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser. Ophthalmology 109:1575–1582CrossRefPubMedGoogle Scholar
  21. 21.
    Dolman PJ (2003) Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Ophthalmol 110:78–84CrossRefGoogle Scholar
  22. 22.
    Tsirbas A, Wormald PJ (2003) Endonasal dacryocystorhinostomy with mucosal flaps. Am J Ophthalmol 135:76–83CrossRefPubMedGoogle Scholar
  23. 23.
    Couch SM, White WL (2004) Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction. Ophthalmology 111:585–589CrossRefPubMedGoogle Scholar
  24. 24.
    Song HY, Anh HS, Park CK et al (1993) Complete obstruction of the nasolacrimal system: part I. Treatment with balloon dilatation. Radiology 186:367–371PubMedGoogle Scholar
  25. 25.
    Ko GY, Song HY, Seo TS et al (2003) Obstruction of the lacrimal system: treatment with a covered, retrievable expandable nitinol stent versus a lacrimal polyurethane stent. Radiology 227:270–276CrossRefPubMedGoogle Scholar
  26. 26.
    Chiambaretta F, Modif R, Gerbaud L et al (2003) Stenting of lacrimal canal obstructions: a cost efficiency analysis [abstract 35.6.3]. Cardiovasc Intervent Radiol Soc Europe 1(Suppl CIRSE):63Google Scholar
  27. 27.
    Lanciego C, De Miguel S, Perea M et al (2001) Nasolacrimal stents in the management of epiphora: medium-term results of a multicenter prospective study. J Vasc Intervent Radiol 12:701–710CrossRefGoogle Scholar
  28. 28.
    Yazici Z, Yazici B, Parlak M et al (2002) Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results. Am J Radiol 179:491–494Google Scholar
  29. 29.
    Pulido-Duque JM, Reyes R, Carreira JM et al (1998) Treatment of complete and partial obstruction of the nasolacrimal system with polyurethane stents: initial experience. Cardiovasc Intervent Radiol 21:41–45CrossRefPubMedGoogle Scholar
  30. 30.
    Song HY, Jin YH, Kim JH et al (1996) Non-surgical placement of a nasolacrimal polyurethane stent: long-term effectiveness. Radiology 200:759–763PubMedGoogle Scholar
  31. 31.
    Pinto IT, Paul L, Vicente JM et al (1998) Nasolacrimal polyurethane stent: complications with CT correlation. Cardiovasc Intervent Radiol 21:450–453CrossRefPubMedGoogle Scholar
  32. 32.
    Song HY, Jin YH, Kim JH et al (1995) Nonsurgical placement of a lacrimal polyurethane stent. Radiology 194:233–237PubMedGoogle Scholar
  33. 33.
    Paul L, Pinto I, Vicente JM et al (2002) Nasolacrimal stent in the treatment of epiphora: long-term results. J Vasc Intervent Radiol 13:83–88CrossRefGoogle Scholar
  34. 34.
    Lanciego C, García García L (2008) Nasolacrimal duct interventions. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Zollikofer CL (eds) Image-guided interventions. Elsevier, Philadelphia, PA, pp 697–699Google Scholar
  35. 35.
    Ferrer-Puchol M, Esteban-Hernandez E, Jornet-Frayos J et al (2009) Treatment of lacrimal duct obstruction with a Tear-Leader stent. Arch Soc Esp Oftalmol 84:515–522Google Scholar
  36. 36.
    Becker BB (2001) Recanalization of the obstructed nasolacrimal duct system [editorial]. J Vasc Intervent Radiol 12:69–7699Google Scholar
  37. 37.
    Kim JH, Shin JH, Song H-Y et al (2006) Long-term results and factors affecting patency after removal of nasolacrimal stents. J Vas Interv Radiol 17:1125–1130CrossRefGoogle Scholar
  38. 38.
    Janssen AG, Mansour K, Bos JJ et al (2000) Abscess of the lacrimal sac due to chronic or subacute dacryocistitis: treatment with temporary stent placement in the nasolacrimal duct. Radiology 215:300–304PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Juan J. Ciampi
    • 1
  • Carlos Lanciego
    • 1
  • Sofia Navarro
    • 2
  • Rafael Cuena
    • 3
  • Javier Velasco
    • 1
  • Miguel Perea
    • 2
  • Lorenzo García-García
    • 1
  1. 1.Interventional Radiology Unit, Department of RadiologyHospital Virgen de la Salud, Complejo Hospitalario de ToledoToledoSpain
  2. 2.Ophthalmology ServiceHospital Virgen de la SaludToledoSpain
  3. 3.Research-Statistics Unit of the Hospital Virgen de la Salud, Complejo Hospitalario de ToledoToledoSpain

Personalised recommendations