(Radiology. 2000;214:781-786.)
© RSNA, 2000
Vascular and Interventional Radiology |
Balloon Catheter Dilation in Common Canalicular Obstruction of the Lacrimal System: Safety and Long-term Effectiveness1
Gi Young Ko, MD,
Deok Hee Lee, MD,
Hyo-Sook Ahn, MD,
Hyun Ki Yoon, MD,
Kyu-Bo Sung, MD and
Ho-Young Song, MD
1 From the Department of Diagnostic Radiology, Kangnam St Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul (G.Y.K.), and the Departments of Diagnostic Radiology (D.H.L., H.K.Y., K.B.S., H.Y.S.) and Ophthalmology (H.S.A.), Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-ku, Seoul 138-736, Korea. From the 1997 RSNA scientific assembly. Received April 27, 1998; revision requested July 6; final revision received June 9, 1999; accepted August 18. Address reprint requests to H.Y.S. (e-mail: hysong@www.amc.seoul.kr).
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Abstract
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PURPOSE: To evaluate the safety and long-term effectiveness of balloon catheter dilation in the treatment of common canalicular obstruction of the lacrimal system.
MATERIALS AND METHODS: Fluoroscopically guided dilation with a 3-mm-diameter balloon catheter was attempted in 195 eyes of 148 patients (26 men, 122 women; mean age, 57 years; age range, 33–78 years) with epiphora due to common canalicular obstruction. Eighty-four of 195 eyes had complete obstruction, and 111 had partial obstruction.
RESULTS: Complications were self-limited nasal bleeding (n = 8), false passage (n = 7), and extravasation of contrast material (n = 6). Initial technical success was achieved in 76 (90%) of 84 eyes with complete obstruction and in 104 (94%) of 111 eyes with partial obstruction. In the 180 eyes with technical success, immediate clinical improvement was achieved in 76 eyes with complete obstruction and in 100 eyes with partial obstruction. The mean follow-up period was 36 weeks (range, 4–168 weeks). The cumulative patency rates were 51% at 6-month, 43% at 12-month, and 40% at 24-month follow-up.
CONCLUSION: Although the long-term recurrence rate is relatively high, balloon catheter dilation is a safe and effective therapeutic technique to be used initially in common canalicular obstruction.
Index terms: Eye, diseases, 223.20, 223.49 • Lacrimal gland and duct, interventional procedures, 223.1269 • Lacrimal gland and duct, radiography, 223.1295
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Introduction
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The common canaliculus is the second most common site of lacrimal system obstruction after the junction of the lacrimal sac and the nasolacrimal duct (1). The standard surgical treatment of epiphora resulting from canalicular obstruction is conjunctival dacryocystorhinostomy with a permanent bypass tube (2). However, this surgery has several disadvantages, including invasiveness, residual facial scarring, risks associated with general anesthesia, and a high rate of recurrence at long-term follow-up. A variety of nonsurgical treatment methods have been proposed (3,4). Although probing and silicone intubation are effective methods to treat canalicular obstruction, they are associated with high recurrence and complication rates (3). A plastic stent placement technique has been developed to treat canalicular obstruction; however, it has not had widespread approval (4).
Balloon catheter dilation of the lacrimal system has been reported to be a safe, easy, and effective treatment for lacrimal sac or nasolacrimal ductal obstruction (5–14). Yet many investigators (11–15) have assumed that balloon catheter dilation of the common canaliculus is contraindicated because of the risk of canalicular damage. On the other hand, some investigators (8–10) have reported that balloon catheter dilation of the common canaliculus is safe and effective. All of these reports, however, have involved only small numbers of patients with limited follow-up. The purpose of this study was to determine the safety and long-term effectiveness of balloon catheter dilation in 195 eyes of 148 patients with epiphora caused by complete or partial obstruction of the common canaliculus.
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MATERIALS AND METHODS
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Between October 1993 and October 1997, we attempted balloon catheter dilation in 195 eyes of 148 consecutive patients (26 men, 122 women; mean age, 57 years; age range, 33–78 years) who presented with epiphora due to common canalicular obstruction. Epiphora was bilateral in 47 patients. One hundred nineteen patients did not respond to standard probing or dacryocystorhinostomy. Patients with active dacryocystitis were excluded from this study because balloon catheter dilation of an infected lacrimal system could result in the spread of infection to surrounding tissues. In addition, combined lesions in the common canaliculus and other parts of the lacrimal system were excluded in this study.
The average interval between the onset of symptomatic epiphora and initial balloon catheter dilation was 7 years (range, 3 months to 40 years). The causes of epiphora were idiopathic in 187 eyes, infection in four eyes, and trauma in four eyes. To assess clinical improvement, we classified epiphora into one of six grades ranging from 0 (no epiphora) to 5 (constant tearing), as was done previously (7). The symptoms indicated grade 5 epiphora in 175 eyes, grade 4 in nine eyes, grade 3 in 10 eyes, and grade 2 in one eye.
The site and severity of obstruction were evaluated before balloon catheter dilation by means of dacryocystography. The dacryocystograms of eighty-four eyes showed complete obstruction at the level of the common canaliculus, and those of 111 eyes showed stricture—that is, partial obstruction—in the common canaliculus. Balloon catheter dilation was performed after written informed consent was obtained from all patients. After local anesthesia was induced, negotiation of the obstructed common canaliculus with a ball-tipped guide wire (Sooho Medi-tech, Seoul, Korea) was performed, as was done previously (7,10). Then, we advanced a 3-mm-diameter lacrimal balloon catheter (Balt, Montmorency, France) retrogradely over the guide wire until the distal radiopaque marker (not the distal tip) of the balloon catheter passed the punctum. After balloon catheter dilation of the canaliculus for 2 minutes, we routinely dilated the subcanalicular parts of the lacrimal system by using a 3- or 4-mm-diameter balloon catheter. Dacryocystography was then performed immediately after the procedure to verify the patency of the lacrimal system. Oral antibiotics, as well as topical antibiotic-steroid eye drops, were continued for 1 week after the procedure.
Follow-up dacryocystography was performed 1 week, 2 months, 6 months, and 12 months after the procedure. Patients were also contacted by telephone every 3 months to obtain follow-up information, and those who reported having recurrent epiphora underwent dacryocystography. We defined technical success as adequate passage of contrast material through the entire lacrimal system without a false passage on the immediate postprocedural dacryocystogram. We defined clinical success as cure, when epiphora disappeared, or as clinical improvement, when epiphora improved more than two grades. The differences in the initial technical success rates between the eyes with complete and partial obstruction were tested with the 
2 test. Long-term results were evaluated by using the cumulative patency rates calculated with the Kaplan-Meier method.
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RESULTS
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All patients experienced mild to moderate pain during dilator insertion and balloon inflation, but none of them needed sedation. No major complications occurred. The minor procedure-related complications that occurred in 21 patients were self-limited nasal bleeding (n = 8) that persisted longer than 24 hours, false passage (n = 7), and extravasation of contrast material (n = 6).
Initial technical success was achieved in 76 (90%) of 84 eyes with complete obstruction and in 104 (94%) of 111 eyes with partial obstruction (Figs 1, 2). The overall technical failure rate was 8%—15 of 195 eyes. The technical failures were due to false passage through the submucosa or periosteum of the lacrimal system by the guide wire in four eyes with partial obstruction and in three eyes with complete obstruction, failed negotiation of the obstructed canaliculus with the guide wire in three eyes with partial obstruction and in one eye with complete obstruction, and poor passage through the lacrimal system after the procedure in four eyes with complete obstruction.
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Figure 1a. (a) Anteroposterior subtraction dacryocystogram obtained before balloon catheter dilation in a 58-year-old woman shows complete obstruction (arrow) of the left common canaliculus. (b) On the drawn illustration of a, the thick black lines are the superior and inferior canaliculi (arrowheads) and common canaliculus (solid straight arrow). The lacrimal sac (open arrow) and nasolacrimal duct (curved arrow) also are illustrated. (c) Frontal radiograph of the lacrimal system obtained during balloon catheter dilation shows an hourglass deformity (arrow) from the balloon contour at the common canaliculus. (d) On the drawn illustration of c, the superior punctum (solid straight arrow) and canaliculus (arrowhead) are tilted medially and superiorly, with respect to their normal position, after passage of the guide wire and balloon catheter (curved arrows). The common canaliculus (open arrow) also is illustrated. (e) Follow-up dacryocystogram obtained 1 year after balloon catheter dilation shows recanalyzed common canaliculus (solid arrow). Note the good passage of contrast material through the nasolacrimal duct (open arrows) into the inferior meatus (asterisk) of the nasal cavity.
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Figure 1b. (a) Anteroposterior subtraction dacryocystogram obtained before balloon catheter dilation in a 58-year-old woman shows complete obstruction (arrow) of the left common canaliculus. (b) On the drawn illustration of a, the thick black lines are the superior and inferior canaliculi (arrowheads) and common canaliculus (solid straight arrow). The lacrimal sac (open arrow) and nasolacrimal duct (curved arrow) also are illustrated. (c) Frontal radiograph of the lacrimal system obtained during balloon catheter dilation shows an hourglass deformity (arrow) from the balloon contour at the common canaliculus. (d) On the drawn illustration of c, the superior punctum (solid straight arrow) and canaliculus (arrowhead) are tilted medially and superiorly, with respect to their normal position, after passage of the guide wire and balloon catheter (curved arrows). The common canaliculus (open arrow) also is illustrated. (e) Follow-up dacryocystogram obtained 1 year after balloon catheter dilation shows recanalyzed common canaliculus (solid arrow). Note the good passage of contrast material through the nasolacrimal duct (open arrows) into the inferior meatus (asterisk) of the nasal cavity.
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Figure 1c. (a) Anteroposterior subtraction dacryocystogram obtained before balloon catheter dilation in a 58-year-old woman shows complete obstruction (arrow) of the left common canaliculus. (b) On the drawn illustration of a, the thick black lines are the superior and inferior canaliculi (arrowheads) and common canaliculus (solid straight arrow). The lacrimal sac (open arrow) and nasolacrimal duct (curved arrow) also are illustrated. (c) Frontal radiograph of the lacrimal system obtained during balloon catheter dilation shows an hourglass deformity (arrow) from the balloon contour at the common canaliculus. (d) On the drawn illustration of c, the superior punctum (solid straight arrow) and canaliculus (arrowhead) are tilted medially and superiorly, with respect to their normal position, after passage of the guide wire and balloon catheter (curved arrows). The common canaliculus (open arrow) also is illustrated. (e) Follow-up dacryocystogram obtained 1 year after balloon catheter dilation shows recanalyzed common canaliculus (solid arrow). Note the good passage of contrast material through the nasolacrimal duct (open arrows) into the inferior meatus (asterisk) of the nasal cavity.
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Figure 1d. (a) Anteroposterior subtraction dacryocystogram obtained before balloon catheter dilation in a 58-year-old woman shows complete obstruction (arrow) of the left common canaliculus. (b) On the drawn illustration of a, the thick black lines are the superior and inferior canaliculi (arrowheads) and common canaliculus (solid straight arrow). The lacrimal sac (open arrow) and nasolacrimal duct (curved arrow) also are illustrated. (c) Frontal radiograph of the lacrimal system obtained during balloon catheter dilation shows an hourglass deformity (arrow) from the balloon contour at the common canaliculus. (d) On the drawn illustration of c, the superior punctum (solid straight arrow) and canaliculus (arrowhead) are tilted medially and superiorly, with respect to their normal position, after passage of the guide wire and balloon catheter (curved arrows). The common canaliculus (open arrow) also is illustrated. (e) Follow-up dacryocystogram obtained 1 year after balloon catheter dilation shows recanalyzed common canaliculus (solid arrow). Note the good passage of contrast material through the nasolacrimal duct (open arrows) into the inferior meatus (asterisk) of the nasal cavity.
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Figure 1e. (a) Anteroposterior subtraction dacryocystogram obtained before balloon catheter dilation in a 58-year-old woman shows complete obstruction (arrow) of the left common canaliculus. (b) On the drawn illustration of a, the thick black lines are the superior and inferior canaliculi (arrowheads) and common canaliculus (solid straight arrow). The lacrimal sac (open arrow) and nasolacrimal duct (curved arrow) also are illustrated. (c) Frontal radiograph of the lacrimal system obtained during balloon catheter dilation shows an hourglass deformity (arrow) from the balloon contour at the common canaliculus. (d) On the drawn illustration of c, the superior punctum (solid straight arrow) and canaliculus (arrowhead) are tilted medially and superiorly, with respect to their normal position, after passage of the guide wire and balloon catheter (curved arrows). The common canaliculus (open arrow) also is illustrated. (e) Follow-up dacryocystogram obtained 1 year after balloon catheter dilation shows recanalyzed common canaliculus (solid arrow). Note the good passage of contrast material through the nasolacrimal duct (open arrows) into the inferior meatus (asterisk) of the nasal cavity.
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Figure 2a. (a) Anteroposterior bilateral subtraction dacryocystogram obtained before balloon catheter dilation in a 51-year-old woman shows complete obstruction (arrow) of the left common canaliculus and partial obstruction (arrowhead) of the right common canaliculus. (b) On the drawn illustration of a, the thick black lines are the lacrimal system. The superior and inferior canaliculi (arrowheads), common canaliculus (straight solid arrow), lacrimal sac (open arrow), and nasolacrimal duct (curved arrow) are illustrated. (c) One-year follow-up dacryocystogram shows patency of both the common canaliculi (solid arrows) and nasolacrimal ducts (open arrows).
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Figure 2b. (a) Anteroposterior bilateral subtraction dacryocystogram obtained before balloon catheter dilation in a 51-year-old woman shows complete obstruction (arrow) of the left common canaliculus and partial obstruction (arrowhead) of the right common canaliculus. (b) On the drawn illustration of a, the thick black lines are the lacrimal system. The superior and inferior canaliculi (arrowheads), common canaliculus (straight solid arrow), lacrimal sac (open arrow), and nasolacrimal duct (curved arrow) are illustrated. (c) One-year follow-up dacryocystogram shows patency of both the common canaliculi (solid arrows) and nasolacrimal ducts (open arrows).
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Figure 2c. (a) Anteroposterior bilateral subtraction dacryocystogram obtained before balloon catheter dilation in a 51-year-old woman shows complete obstruction (arrow) of the left common canaliculus and partial obstruction (arrowhead) of the right common canaliculus. (b) On the drawn illustration of a, the thick black lines are the lacrimal system. The superior and inferior canaliculi (arrowheads), common canaliculus (straight solid arrow), lacrimal sac (open arrow), and nasolacrimal duct (curved arrow) are illustrated. (c) One-year follow-up dacryocystogram shows patency of both the common canaliculi (solid arrows) and nasolacrimal ducts (open arrows).
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Although the initial technical success rate in the cases with partial obstruction was slightly higher than that in the cases with complete obstruction, there was no statistically significant difference between these two groups (P > .05). In the 180 eyes with technical success, immediate clinical improvement was achieved in 76 eyes with complete obstruction and in 100 eyes with partial obstruction. Thus, initial clinical success was achieved in 90% (76 of 84 eyes) with complete obstruction and in 90% (100 of 111 eyes) with partial obstruction.
The mean follow-up period was 36 weeks (range, 4–168 weeks). In the 76 eyes with complete obstruction in which clinical success was achieved, recurrent epiphora occurred in 38 cases in the first 6 months, for a 6-month patency rate of 50% (Fig 3) (Table). Recurrent epiphora occurred in eight cases during the second 6 months and in two cases following 1 year, giving a 1-year patency rate of 39% and a 2-year patency rate of 37%. Whereas in 100 eyes with partial obstruction in which clinical success was achieved, recurrent epiphora occurred in 49 cases in the first 6 months, for a 6-month patency rate of 51%. Recurrent epiphora occurred in six cases during the second 6 months and in two cases after 1 year, for a 1-year patency rate of 45% and a two-year patency rate of 43% (Table). Thus, a cumulative 2-year patency rate was achieved in 40% of 176 eyes with complete or partial obstruction. Although the cumulative patency rates were slightly higher in the cases with partial obstruction than in those with complete obstruction, there was no statistically significant difference between these two groups (P > .05).
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Figure 3. Graph illustrates the difference in cumulative patency rates between the 76 complete obstructions and the 100 partial obstructions after balloon catheter dilation. The arrow indicates the point when the recurrence of obstruction seemed to remain relatively stable during the follow-up period.
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Among the 105 eyes in which epiphora recurred during the follow-up, 10 eyes with complete obstruction and 11 eyes with partial obstruction were treated with repeat balloon catheter dilation. Repeat balloon catheter dilation resulted in clinical improvement in eight (80%) eyes with complete obstruction and in six (55%) eyes with partial obstruction. In addition, clinical improvement was maintained through the last follow-up examination in five (50%) eyes with complete obstruction and in four (36%) eyes with partial obstruction. The remaining eyes were treated with stent placement (n = 19), silicone intubation (n = 2), or dacryocystorhinostomy (n = 4). Fifty-nine eyes were not treated interventionally because the patient refused to undergo an additional procedure.
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DISCUSSION
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Traditionally, balloon catheter dilation of the common canaliculus has been contraindicated because of possible damage to the canaliculus or punctum (11–14). Glatt (15) stressed that balloon catheter dilation is not suitable for canalicular stenosis and that the canaliculus should not be dilated beyond the diameter of the guide wire or lacrimal catheter. However, a few studies (7–10) of balloon catheter dilation in the common canaliculus, with few cases and limited follow-up, have been reported. Lee et al (8) reported a 46% initial success rate, and Ilgit et al (9) reported a 62% initial success rate and 100% patency rate, with a mean follow-up of 13 months. In addition, Song et al (10) reported a 73% initial success rate and 38% 6-month patency rate. In our study, we achieved an initial clinical success rate of 90% and a 2-year cumulative patency rate of 40%. To our knowledge, our initial clinical success rate was higher than any reported previously, and the follow-up period was the longest for common canalicular obstruction.
The differences in patient numbers and balloon catheter dilation techniques probably explain the differences in results. Ilgit et al (9) dilated 13 common canaliculi by using a 2-mm-diameter balloon. Lee et al (8) and Song et al (10) used a 2- or 3-mm-diameter balloon to dilate common canalicular obstructions. However, to prevent possible damage to the canaliculus or punctum during balloon inflation, they performed balloon catheter dilation after the distal tip (not the distal radiopaque marker) of a 3-mm-diameter balloon catheter was advanced only as far as the punctum. In this study, the 3-mm portion of the balloon catheter was located in the lacrimal sac and common canaliculus, and the gradually tapered portion of the balloon catheter was located in the superior canaliculus. However, this technique is relatively difficult because the balloon catheter can slip inferiorly during balloon inflation. Thus, in this study, we advanced the distal radiopaque marker (not the distal tip) of the balloon catheter beyond the punctum in all the eyes so the center of the balloon catheter could be located in the common canaliculus, superior canaliculus, and punctum. Thus, the balloon catheter was more stable during inflation, and the ballooning effect was greater than that in the previously reported technique.
Anatomically, the conjunctiva and sclera are a short distance from the punctum. Thus, the protrusion of the balloon catheter beyond the punctum may induce conjunctival or scleral damage. However, the superior punctum and canaliculus were tilted to the medial and superior sides of their normal position after the guide wire passage. Thus, the distal tip of the balloon catheter did not damage the conjunctiva and sclera. No major complications in the punctum, conjunctiva, or sclera from either balloon catheter insertion or balloon inflation were observed in our study. Thus, we suggest that this modified technique, with a 3-mm-diameter balloon catheter, is better for common canalicular dilation than the previously reported technique.
For common canalicular dilation, Lee et al (8) and Ilgit et al (9) inflated a balloon for at least 5 minutes, and Song et al (10) inflated a balloon for 1-2 minutes. Munk et al (6) and Janssen et al (12,13) inflated a balloon two or three times for 30 seconds for nasolacrimal ductal balloon catheter dilation. In this study, we obtained encouraging results by inflating the balloon for 2 minutes. Balloon inflation for more than 2 minutes also could be effective in dilating the obstructed lacrimal system, but it may be time-consuming and induce ischemic damage to some areas of the lacrimal system. Thus, we believe that the most effective inflation time is yet to be determined; 2 minutes may be sufficient to tear the fibrotic component of the obstruction.
Another difference in our technique was the negotiation of the obstructed canaliculus with a guide wire. Accurate negotiation with a guide wire through the obstructed canaliculus is one of the most important steps of this procedure. To minimize trauma to the lacrimal system, some investigators (6,9,12–14) have used a soft-tipped guide wire and experienced no difficulty in passing the guide wire, even when there was complete obstruction. However, Song et al (7) and Robinson et al (16) reported that it is impossible to negotiate the soft-tipped guide wire through a completely obstructed canaliculus. In our opinion, the negotiation of the tight, obstructed canaliculus with the soft tip of the guide wire is very difficult because of the tip's flexibility. To overcome this difficulty, we used a relatively stiff, ball-tipped guide wire that was developed by Song et al (7). By using a ball-tipped guide wire, we negotiated the obstructed canaliculus successfully in almost all the cases. The ball-tipped guide wire, however, may increase the risk of ductal wall damage or creating a false tract. In our study, we had seven cases of false passage. In these seven cases, there was recurrence of obstruction on the 1-week follow-up dacryocystogram, although there was good passage of contrast material through the false tract immediately after balloon catheter dilation. Therefore, it is important not to make a false tract while negotiating a ball-tipped guide wire through the obstructed lumen of the lacrimal system.
The recurrence of obstruction seemed to be related mainly to ductal wall damage that occurred during guide wire or balloon catheter manipulation and to follow mucosal overgrowth, fibrosis, and recurrent episodes of active dacryocystitis (14). To prevent mucosal overgrowth and active dacryocystitis, we routinely administered oral antibiotics and applied topical antibiotic-steroid eye drops for 1 week following the procedure. However, recurrence of obstruction was inevitable; further investigation is needed to determine the proper management after balloon catheter dilation. It is noteworthy that in our study, epiphora recurred relatively frequently until about the 9-month follow-up examination after the procedure, but it seemed to remain relatively stable thereafter (Fig 3). The cumulative patency rate did not reach a plateau, yet a tendency toward recurrence of obstruction secondary to mucosal overgrowth or fibrosis was observed up to 9 months after balloon catheter dilation. Thus, we assume that follow-up dacryocystography may not be routinely necessary after the 9-month follow-up examination.
Although the recurrence rate was relatively high, 40% of the cases of epiphora had improvement through the last follow-up. Thus, surgery was not needed in these patients. If epiphora recurs, then balloon catheter dilation can be repeated without substantial complications. In addition, surgery can be performed in cases of recurrent epiphora after balloon catheter dilation without further difficulty because balloon catheter dilation does not alter the anatomy of the lacrimal system. In conclusion, balloon catheter dilation is a safe and effective initial therapeutic technique to treat common canalicular obstruction.
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Footnotes
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Author contributions: Guarantors of integrity of entire study, G.Y.K., H.Y.S., study concepts, G.Y.K., H.Y.S., H.S.A.; study design, G.Y.K., H.Y.S.; definition of intellectual content, H.K.Y., K.B.S.; literature research, G.Y.K., H.Y.S.; clinical studies, all authors; data acquisition, G.Y.K., H.Y.S., H.K.Y.; data analysis, G.Y.K., H.Y.S.; statistical analysis, G.Y.K., D.H.L.; manuscript preparation, G.Y.K.; manuscript editing, H.Y.S., K.B.S.; manuscript review, H.S.A., H.K.Y., D.H.L.
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References
|
|---|
-
Malik SRK, Gupta AK, Chaterjee S, Bhardwaj OP, Saha M. Dacryocystography of normal and pathological lacrimal passages. Br J Ophthalmol 1969; 53:174-179.[Free Full Text]
-
Steinsapir KD, Glatt HJ, Putterman AM. A 16-year study of conjunctival dacryocystorhinostomy. Am J Ophthalmol 1990; 109:387-393.[Medline]
-
Veloudios A, Harvey JT, Philippon M. Long-term placement of silastic nasolacrimal tubes. Ophthalmic Surg 1991; 22:225-227.[Medline]
-
Song HY, Lee CO, Park SS, et al. Lacrimal canaliculus obstruction: nonsurgical treatment with a newly designed polyurethane stent. Radiology 1996; 199:280-282.[Abstract/Free Full Text]
-
Becker BB, Berry FD. Balloon catheter dilatation in lacrimal surgery. Ophthalmic Surg 1989; 20:193-198.[Medline]
-
Munk PL, Lin DTC, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology 1990; 177:687-690.[Abstract/Free Full Text]
-
Song HY, Ahn HS, Park CK, Kwon SH, Kim CS, Choi KC. Complete obstruction of the nasolacrimal system. I. Treatment with balloon dilation. Radiology 1993; 186:367-371.[Abstract/Free Full Text]
-
Lee JM, Song HY, Han YM, et al. Balloon dacryocystoplasty: results in the treatment of complete and partial obstructions of the nasolacrimal system. Radiology 1994; 192:503-508.[Abstract/Free Full Text]
-
Ilgit ET, Yuksel D, Unal M, Akpek S, Isik S, Hasanreisoglu B. Transluminal balloon dilatation of the lacrimal drainage system for the treatment of epiphora. AJR Am J Roentgenol 1995; 165:1517-1524.[Abstract/Free Full Text]
-
Song HY, Lee CO, Park S, et al. Lacrimal canalicular obstruction: Safety and effectiveness of balloon dilation. J Vasc Interv Radiol 1996; 7:929-934.[Medline]
-
McCullough KM. Nasolacrimal duct balloon dilatation. Clin Radiol 1994; 49:787-790.[Medline]
-
Janssen AG, Mansour K, Krabbe GJ, van der Veen S, Helder AH. Dacryocystoplasty: treatment of epiphora by means of balloon dilation of the obstructed nasolacrimal duct system. Radiology 1994; 193:453-456.[Abstract/Free Full Text]
-
Janssen AG, Mansour K, Bos JJ. Obstructed nasolacrimal duct system in epiphora: long-term results of dacryocystoplasty by means of balloon dilation. Radiology 1997; 205:791-796.[Abstract/Free Full Text]
-
Berkefeld J, Kirchner J, Muller HM, Fries U, Kollath J. Balloon dacryocystoplasty: indications and contraindications. Radiology 1997; 205:785-790.[Abstract/Free Full Text]
-
Glatt HJ. Dacryocystoplasty: an oculoplastic surgeon's perspectives (letter). Radiology 1991; 180:289.[Free Full Text]
-
Robinson R, Turner N, Brettle P, Chell PB, Chavda SV, Murray PI. The treatment of epiphora with balloon dacryocystoplasty. Eye 1993; 7:687-690.
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Abstract
Introduction
