Endocanalicular Investigation and Endoscopic Treatment of Lacrimal Obstruction

Endocanalicular investigation has provided several new insights into the lacrimal system and in understanding of lacrimal diseases. The advent of superfine flexible endoscopes, originally developed as gastroduodenal endoscopes for endoscopic retrograde cholangiopancreatography, enabled the microendoscopic examination. Endoscopically, different parts of the lacrimal system can be recognised based on their colour and lumen width, such as the white homogeneous structure of the canaliculi, the reddish-grey mucosa of the lacrimal sac, the Rosenmüller fold, and Krause fold at the sac-nasolacrimal duct junction. Idiopathic obstruction can be seen in these folds, especially at the Krause fold, and can usually be reopened with microendoscopic procedures. An Erbium YAG or diode laser is used for opening of complete stenoses, while the microdrill is utilised for subtotal stenoses, especially at the Krause fold. These procedures have been established as laser dacryoplasty and microdrill dacryoplasty with reasonable success rates, and may potentially reduce the need for dacryocystorhinostomy.