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Neuroradiology Case of the Week

Case 234

Sara Ann Majewski, MD

Clinical Presentation: Patient is a 57-year-old female with longstanding eustachian tube dysfunction and recurrent episodes of otitis externa requiring lacrimal duct stent placement for severe canalicular disease of the left eye.

Imaging Findings: Lacrimal duct stent is seen within the left lacrimal duct.

Diagnosis: Canalicular disease of the left eye

Discussion: In the mid to late 1990’s, nasolacrimal ducts were designed and placed under fluoroscopy. Nasolacrimal duct stent placement may be used to treat epiphora and chronic abscess.
     Epiphora is a watery eye, secondary to poor drainage of tears, commonly caused by idiopathic inflammatory obstruction of the nasolacrimal duct.
     Total obstruction of the lacrimal duct distal to the lacrimal sac can cause chronic abscess. Temporary nasolacrimal duct stent used as an adjunct to antibiotics is a potential treatment that has been described.
     External dacryocystorhinostomy is the conventional treatment for epiphora. This consists of making an anastomosis between the lacrimal sac and the nasal cavity proximal to the obstruction. This surgery has a more than 90% success rate. Disadvantages of the procedure include facial skin incision, large osteotomy through the lateral nasal wall, and, occasionally, general anesthesia.
     Balloon dilatation has also been described as another non-invasive alternative to dacryocystorhinostomy.
     The success rate of the nasolacrimal duct stenting is low compared to dacryocystorhinostomy. The stent can cause changes of the of the lacrimal sac tissue which can create difficulty with subsequent dacryocystorhinostomy.

References:

1. Janssen AG, Mansour K, Bos JJ, Manoliu RA, Castelijns JA. Abscess of the lacrimal sac due to chronic or subacute dacryocystitis: treatment with temporary stent placement in the nasolacrimal duct. Radiology. 2000 Apr;215(1):300-4. [Medline] [PDF]
2. Ko GY, Song HY, Seo TS, Kim TH, Sung KB, Yoon HK. Obstruction of the lacrimal system: treatment with a covered, retrievable, expandable nitinol stent versus a lacrimal polyurethane stent. Radiology. 2003 Apr;227(1):270-6. [Medline] [PDF]
3. Yazici Z, Yazici B, Parlak M, Tuncel E, Erturk H. Treatment of nasolacrimal duct obstruction with polyurethane stent placement: long-term results. AJR Am J Roentgenol. 2002 Aug;179(2):491-4. [Medline] [PDF]