The efficacy of sleeve technique in primary nasolacrimal duct obstruction with a high lacrimal sac

PURPOSE: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) in primary nasolacrimal duct obstruction (NLDO) patients with a high lacrimal sac. MATERIALS AND METHODS: The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. RESULTS: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042). CONCLUSIONS: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.