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CardioVascular and Interventional Radiology

, Volume 21, Issue 6, pp 450–453 | Cite as

Nasolacrimal polyurethane stent: Complications with CT correlation

  • Isabel T. Pinto
  • Laura Paul
  • Carlos Grande
Clinical Investigations

Abstract

Purpose: To evaluate initial results in patients with epiphora secondary to obstruction of the nasolacrimal duct treated by placement of a polyurethane stent, and to discuss the technical problems and complications arising during the procedure, with visualization of the anatomy of the drainage apparatus using computed tomography (CT).

Methods: We inserted 20 polyurethane Song stents under fluoroscopic guidance after dacryocystography in 19 patients with grade 3–4 epiphora caused by idiopathic obstruction of the nasolacrimal duct. CT scans were obtained following stent placement in all patients.

Results: We focus on the technical problems and complications that arose during these procedures. During negotiation of the guidewire past the obstruction at the level of the junction of the duct with the lacrimal sac, the guidewire created a false passage in a posterior suborbital direction in two cases and towards the posterior midline in another. In all cases the guidewire was withdrawn and reinserted through the proper anatomic route without further difficulty or complications. In two cases the stent was improperly positioned wholly or partially outside the nasolacrimal system (one medially, one posteriorly). In one case the stent was removed and reinserted; in the other it remains in place and functional. CT was performed in all these cases to ensure proper anatomic alignment and determine what had gone wrong. The epiphora was completely resolved in 13 cases and partially relieved in four; there were three cases of stent obstruction. Epistaxis of short duration (1 hr) occurred in seven patients and headache in one.

Conclusions: Treatment of epiphora with polyurethane stents is a technique that is well tolerated by patients and achieves a high success rate, yet problems in placement may be encountered. Though no major consequences for patients are involved, cognizance of such difficulties is important to avoid incorrect positioning of stents.

Key words

Lacrimal gland and duct Interventional procedure 

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References

  1. 1.
    Song HY, Jin YH, Kim JH, Huh SJ, Kim YH, Kim TH, Sung KB (1995) Non-surgical placement of a nasolacrimal polyurethane stent. Radiology 194:233–237PubMedGoogle Scholar
  2. 2.
    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
  3. 3.
    Dryden RM, Wula ARE (1988) Surgery of the lacrimal system. In: Waltman SR, Keates RH, Hoyt CS, Frueh BR, Herschler J, Carroll DM (eds) Surgery of the Eye. Churchill Livingstone, New York, pp 607–628Google Scholar
  4. 4.
    Werb A (1964) Surgery of epiphora. Int Ophthalmol Clin 4:377–397PubMedCrossRefGoogle Scholar
  5. 5.
    Hanafee WN, Dayton GO (1978) Dilatation of the nasolacrimal duct under radiographic control. Radiology 127:813–815PubMedGoogle Scholar
  6. 6.
    Song HY, Ahn HS, Park CK, Kwon SH, Kim CS, Choi KC (1993) Complete obstruction of the nasolacrimal system. I. Treatment with balloon dilation. Radiology 186:367–371PubMedGoogle Scholar
  7. 7.
    Lee JM, Song HY, Han YM, Chung GH, Sohn MH, Kim CS, Choi KC (1994) Balloon dacryocystoplasty: Results in the treatment of complete and partial obstructions of the nasolacrimal system. Radiology 192: 503–508PubMedGoogle Scholar
  8. 8.
    Janssen AG, Mansour K, Krabbe GS, van der Veen S, Helder AH (1994) Dacryocystoplasty: Treatment of epiphora by means of balloon dilation of the obstructed nasolacrimal duct system. Radiology 193: 453–456PubMedGoogle Scholar
  9. 9.
    Song HY, Ahn HS, Park CK, Kwon SH, Kim CS, Choi KC (1993) Complete obstruction of the nasolacrimal system. II. Treatment with expandable metallic stents. Radiology 186:372–376PubMedGoogle Scholar
  10. 10.
    Song HY, Jin YH, Kim JH, Sung KB, Han YM, Cho NC (1994) Nasolacrimal duct obstruction treated non-surgically with use of plastic stents. Radiology 190:535–539PubMedGoogle Scholar
  11. 11.
    Russell EJ, Czervionke L, Huckman M, Daniels D, McLachlan D (1985) CT of the inferomedial orbit and lacrimal drainage apparatus: Normal and pathologic anatomy. AJR 145:1147–1154PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  • Isabel T. Pinto
    • 1
  • Laura Paul
    • 1
  • Carlos Grande
    • 1
  1. 1.Department of RadiologyHospital Universitario de GetafeGetafe, MadridSpain

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