AIM: To describe the role seal cookie cutter of endoscopic transnasal canaliculorhinostomy (ETC) in refractory common canalicular obstruction (CCO) associated with an absent or unidentifiable lacrimal sac.METHODS: The records of patients with refractory CCO who underwent ETC at the Eye Hospital of Wenzhou Medical University from October 2007 to December 2016 were retrospectively reviewed.RESULTS: Fifty-six patients (56 eyes) with refractory CCO were recruited into the study.Eight patients were excluded due to the presence of a residual lacrimal sac or failure to complete the follow-up duration.The anatomic and functional success rates were both 85.
4% (41/48) at a mean follow-up of 18.6mo.Five cases failed as a result of ostial synechia and two failed because of ostial obstruction by granulation.Postoperative complications included mild green and gold masquerade mask nasal bleeding in 5 cases, dried nasal feeling in 8 cases, and olfactory dysfunction in 4 cases.CONCLUSION: Although being surgically challenging, ETC has comparable findings to its external approach counterpart or conjunctivodacryocystorhinostomy (CDCR) with Jones tube.
And it may prove to be a novel alternate surgical technique for patients with refractory CCO without identifiable lacrimal sac.