I introduce the diagnosis and treatment of the lacrimal drainage system obstruction which causes epiphora.
The obstruction of the lacrimal drainage pathway at any point from the punctum to the nasolacrimal duct induces epiphora. Not only ophthalmologic factors but also rhinological factors such as a post-maxillary sinus surgery cause the obstruction.
In recent years, a number of researchers have reported the obstruction due to the side effects of oral anticancer drug TS1.
Slit lamp microscopy examination, irrigation test, dacryoendoscopy and dacryocystgraphy are used to diagnose this disease. Small-diameter dacryoendoscope enabled us to observe the inside condition of lacrimal passage. Corn Beam CT dacryocystography is available for diagnosis of the obstructed site of tear route and paranasal sinuses disease.
Re-opening or making a new tear route through the lacrimal drainage pathway can relieve the epiphora. Dacryoendoscopic surgery for the obstruction without severe inflammation is one of the initial methods to penetrate the stenosis and obstruction of the lacrimal drainage pathway.
There are two methods, endoscopic endonasal dacryocystorhinostomy （END-DCR） and external dacryocystorhinostomy （EXT-DCR）, which make a new tear route. Both methods have been accepted technique and showed high success rates, especially for obstructions at the nasolacrimal duct. However, clinical comfort defined by patients is higher in END-DCR. A sutureless surgical area with less pain is advantage of this method.
