Dacryo-Fornix-rhinostomy with Two Flaps

Abstract

The two most frequent sites of obstruction of the lacrimal pathways are under the lacrimal sac, in the ductus lacrimonasalis, and over the lacrimal sac, in the canaliculi. The obstruction of the first type already has a satisfactory solution with the different forms of dacryo-cysto-rhinostomies. Obstruction of the second type has a satisfactory resolution only in a limited number of cases. For patients in whom current treatment methods are unsuccessful, a technique of dacryo-fornix-rhinostomy is presented, consisting in opening a new pathway between the infero-medial conjunctival cul-de-sac and the atrial part of the nasal cavity. A piece of bone is removed from the antero-lateral wall of the atrium nasi, and the bottom of the infero-medial conjuctival fornix is opened to the precedent wound. The exposed nasal mucosa is cut into two flaps, one being sutured to the posterior lip, and the other to the anterior lip of the conjuctival wound. A conformer is maintained in the new path for several weeks. The new path has an almost vertical trajectory, making the flow of tears very easy. Blinking and the movements of the eyes have a pumping effect.