Outcomes of 3-mm lacrimal balloon dilation in post-DCR common canalicular mucosal stenosis: A minimally invasive recovery approach

PURPOSE: Failure of external dacryocystorhinostomy (DCR) may result from proximal mucosal stenosis involving the common canaliculus. This study describes a 3mm lacrimal balloon dilation technique for this indication and evaluates outcomes. METHODS: This retrospective study included 21 patients with persistent epiphora after external DCR. All cases showed common canalicular mucosal stenosis on dacryo-CT and a well-positioned osteotomy. A 3mm single use lacrimal balloon was advanced through the canaliculus and inflated twice for 90seconds at 10 to 12 pounds per square inch (PSI) under direct or endoscopic visualization. All patients underwent silicone intubation with a monocanalicular or bicanalicular stent for two months. Functional success was defined as resolution of epiphora and a positive nasopharyngeal irrigation test. RESULTS: Functional success was achieved in 16 of 21 patients (76%). Complications included four lacrimal punctal lacerations and one canalicular obstruction. No difference in complication rates was observed between stent types. Endoscopic visualization confirmed balloon positioning and effective dilation of the mucosal ostium. CONCLUSION: Three-millimeter lacrimal balloon dilation is a reproducible, minimally invasive option for isolated mucosal stenosis of the common canaliculus after failed external DCR. It may be considered an intermediate option before revision of the DCR when the osteotomy is anatomically adequate.