Inferior meatus endoscopy and directed treatment for epiphora: Early experience with a novel approach

Objectives: Epiphora results from obstruction along the nasolacrimal (NL) system. The inferior meatus (IM) is not routinely evaluated. IM pathology is common in patients with epiphora, allowing surgery to be directed at the IM.

Methods: Retrospective review of patients referred for epiphora. Patients underwent office endoscopy of the IM. Patients with identifiable pathology underwent intervention directed at the IM.

Results: Seventeen patients were evaluated, four with bilateral epiphora. Two had no IM disease, and one with pathology refused surgery. The remaining 14 (18 sides) had IM pathology. Two patients were successfully treated in the office. Twelve patients underwent surgery (16 sides). Three NLD orifices were obstructed by a cyst, and the remaining 13 by hypertrophied soft tissue at the level of the NLD orifice. Thirteen of 14 sides with distal NLD pathology had resolution or dramatic improvement and patent NL ducts with IM treatment alone. Obstruction extending proximal to Hasner's valve was found in four NL systems, and three developed recurrent epiphora. Median follow-up was 9 months.

Conclusions: IM endoscopy identified pathology in most constant epiphora patients in this study. Pathology at the distal NL system portends a better outcome, whereas extension to the proximal NL duct had poorer outcome.