The effectiveness of a simultaneous medial spindle procedure for involutional punctal ectropion with lid laxity in patients who require endonasal dacryocystorhinostomy instead of external dacryocystorhinostomy to prevent pump failure

Purpose: The aim of this study was to determine the effectiveness of a concurrent medial spindle procedure (MS) to address involutional punctal ectropion and the proportion of combined surgery in patients who need endonasal dacryocystorhinostomy (DCR) instead of external dacryocystorhinostomy to prevent pump failure. Methods: We conducted a retrospective, interventional study on endonasal DCR and MS procedures performed between March 2004 and January 2009 by a single surgeon (S.H.B.). Patient age, sex, the results of a medial distraction test, the surgical procedure, follow-up duration, and cause of failed surgery were recorded. The indication for the medial spindle procedure was punctal eversion on slit lamp biomicroscopic examination with classifications of grades 2 and 3 on the medial distraction test. Results: Endonasal DCRs were performed on 169 eyes in 121 patients, and DCR and MS (D + M) were performed on 23 eyes in 17 patients. The proportion of combined surgery to total DCR was 13.6%. Our primary success rate was 86.9% in the combined surgery group and 87.2% in the DCR group (P = 0.39). Conclusions: The MS for correction of punctal ectropion concurrently performed with endonasal DCR will be an effective tool to manage epiphora caused by complex situations, such as nasolacrimal duct obstruction and involutional punctal ectropion. We recommend careful examination of the punctum, which is invisible in normal conditions, under slit lamp biomicroscopy before endonasal DCR.