The main complications after surgery are bleeding and infection. Punctal Occlusion (Punctal Cautery) If you have dry eye syndrome, you’re not alone. The bleeding usually subsides in a few hours from surgery and is only a few drops of blood mixing with the tears. teacups full. Therefore, it is important to consider anesthesia choices when undergoing a rhinoplasty procedure. The American Academy of Ophthalmology describes what happens when a tear duct is blocked and provides information about tear duct probing surgery. Care After Blocked Tear Duct Surgery (Nasolacrimal Duct Obstruction) 1 of 3 To Learn More • Ophthalmology 206-987-2177 • Ask your child’s healthcare provider • seattlechildrens.org Free Interpreter Services • In the hospital, ask your nurse. Volume 3 is basically the sequel to Volumes 1 and 2; 93 specialists from nine countries contributed to 32 chapters providing comprehensive coverage of advanced topics in OMF surgery. Fourth, the recovery is immediate. Complications. These plugs go further into the tear duct and may stay in place for many years, offering a more permanent solution to leaking eyes. Endoscopic Tear Duct Surgery. Now, while the silicone tube is still in her tear duct, she has tearing and annoying discharge or … The resection also involved her lower lid tear duct system. Endoscopic orbital procedures are at the forefront of today’s multidisciplinary patient care and team approach to problem-solving. The severity of symptoms and the clinical findings determine the most appropriate treatment, which may not necessarily include surgery. Found inside – Page 332What are potential complications of eye muscle surgery, and what should a patient ... What problems or complications can occur when a tear duct is blocked, ... The easiest solution is to turn over to your other side so that the “good” eye or the eye that has had eye dacryocystorhinostomy (DCR) surgery is on top and you stay on the one side all night. Smith and Nesi’s Ophthalmic Plastic and Reconstructive Surgery, Third Edition has taken the best of the field’s classic reference text and expanded upon it, continuing its reputation as the foremost guide to the subspecialty. People who have dry eyes may experience these complications: Eye infections. Babies can be born with blocked tear ducts or it may develop later in life. Found inside – Page 632GENERAL INFORMATION DEFINITION — An infected or blocked tear duct causes ... RISK INCREASES WITH • Tear duct is not fully developed or formed properly in a ... Tears normally drain from the eye through small tubes called tear ducts, which stretch from the eye into the nose. One such problem is epiphora. As a result of an injury, the bile duct will not be able to work right, leaking bile into the abdomen or blocking the normal flow of bile from the liver. If a tear duct becomes blocked or fails to open, tears cannot drain from the eye properly. Many more illustrations specially commissioned for this edition The surgery that's commonly used to treat blocked tear ducts is called dacryocystorhinostomy (DAK-ree-oh-sis-toe-rye-nohs-tuh-me). Facial plastic surgery complications with significant impact on a patient’s health are usually anesthesia-related. It went great with no complications. Surgery in the past: Previous surgery involving the eyes, eyelid, nose or sinus may result in some scarring of the duct system, which can result in a blocked tear duct later. In fact, it should never be the second or third, either. The stent resulted in a wider tear duct than the first operation which causes an increase in the volume of air coming through the eye tear duct. TRAUMATIC INJURY OF THE THORACIC DUCT A.E. This sac leads to the tear duct. The most common treatment is gently milking or massaging the tear duct 2 to 3 times per day. I will include beginning issues with my eyes, the many doctors visits, diagnoses, etc. The tear duct can be opened either endoscopically through the nose, or by an ‘open’ DCR which accesses the duct obstruction by making an incision along the nose. Probe and Irrigation . It was founded in 1889 using money from a bequest of over $7 million (1873 money, worth 134.7 million dollars in 2016) by city merchant, banker/financier, civic leader and philanthropist Johns Hopkins (1795–1873). This duct passes around some bony structures surrounding your nose. Schaudig@uke.uni-hamburg.de Dacryocystorhinostomy or DCR is among the common oculoplastics surgeries performed for managing epiphora due to nasolacrimal duct obstruction. What is Opening of Tear Duct surgical procedure? But by plugging it up, the tear film is now worse. Excess fluid drains through the tear ducts into the nose. Excessive tearing is a common complaint Dr. Zoumalan evaluates in his patients. In some cases, the tear duct needs to be opened using a probe. Dacryocystorhinostomy (DCR) surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora (water running down the face).A DCR procedure involves removal of bone adjacent to the nasolacrimal sac and incorporating the lacrimal sac with the lateral nasal mucosa in order to bypass the nasolacrimal duct obstruction. This means that the air will have to go up rather than down with gravity. Tear glands and tear ducts are the parts involved in the Opening of Tear Duct procedure. Guzman, L. Rossi, C.L. In addition, the friction caused by the tear duct itself will also assist. (see other posts, links). Found insideThis is a comprehensive, practical guidebook that provides a clear overview and update of current modern techniques of ocular surgery. The chapters will be of interest to a wide audience. This manual covers all aspects of endoscopic surgery of the lacrimal drainage system. What is Opening of Tear Duct surgical procedure? It's vital to discuss with your healthcare provider all possible options. ( … The bad news: the tearing didn't stop. Found inside – Page 447Also utilized for tear duct surgery, orbital decompression, and drainage of mucoceles. • Major risks are related to the possibility of perforation of the ... Witte, S. Smyth Departments of Phlebology and Lymphology (AEG), Mendoza, and Department of Emergency Surgery (LR), Cordoba, Argentina, and the Departments of Surgery (CLW) and Radiology (SS), The University ofArizona College ofMedicine, Tucson, Arizona, USA ABSTRACT In addition, the friction caused by the tear duct itself will also assist. This means that the air will have to go up rather than down with gravity. I had the DCR surgery in Nov. 2011. Sometimes punctal plugs can irritate the tear ducts. When this drainage system gets blocked, it may cause a lot of tearing or eye discharge. Found inside – Page 7Table 5 Visceral complications Lacrimal duct injury Treatment: Ophthalmology consultation should be obtained. Primary repair andstentplacement. Why is the Opening of Tear Duct surgical procedure Performed? Found inside – Page ivThis book explains and elaborates upon the procedure of endoscopic dacryocystorhinostomy in a variety of indications.It systematically deals with the anatomy of the lacrimal drainage system, covering all aspects of gross, endoscopic and ... A blocked tear duct in adults rarely resolves itself if not caused by infection, medication or allergy and it may be necessary to have surgery to open the blocked tear duct. when you get significant amounts of bleeding, i.e. Infection is very rare, but possible. I went to an optometrist who referred me to an opthamologist that flushed my tear duct on 2 different appointments. Even a simple procedure can cause complications. Dry eye syndrome — a disorder of the eye’s tear film that causes it to decrease tear and moisture production — is one of the most common complaints that eye care professionals hear. Found insideSurgical complications of parotid duct transposition in the dog. ... Intra-canalicular gelatin implants in lacrimal punctum surgery. You have a lacrimal gland above the outer corner of each eyelid which produce your tears. What to Expect After Surgery: Generally, a silicone tube may be used to keep the passage from the tear duct to the nose open for proper healing to occur, which may last for two months. The silicone tube may be slightly visible to the public. After surgery, there may be slight bleeding from the nose for several hours. This is a fairly complete list of the risks and complications associated with DCR surgery for block tear ducts. Some nasal bleeding can occur for 1-3 days after surgery but is usually minimal. When you should get worried about the healing: the wound is getting red, and more swollen. With the stents in place, your tear duct cannot close up, but the stents do take up room. A blocked tear duct in adults rarely resolves itself if not caused by infection, medication or allergy and it may be necessary to have surgery to open the blocked tear duct. This manual is designed to cover the full spectrum of surgery of the tear ducts and glands, from the basic methods important to the general ophthalmologist to the most complex procedures done by the oculoplastics subspecialist. In the start of this ordeal, I had bothersome (though not unbearable) epiphora in my left eye. To get the best treatment for lacrimal obstruction surgery you have to be well-informed about the surgical procedure, expected results, and complications. By probing and irrigating your tear ducts, Dr. Silbert is able to gage the severity of your blockage. Abnormal watering of eyes (epiphora) occurs because of an obstruction of the tear ducts, either due to structural problems or infection. April 5, 2015. I was then referred to an oculoplastic doctor. Only when every other method has been utilized exhaustively should such a drastic procedure be considered, and only then after the patient has been fully informed about the how a DCR is performed and what the risks are. The first described stent was made of silver wire and used by Graue in 1932. The polyurethane nasolacrimal duct stent for lower tear duct obstruction: long-term success rate and complications. A swollen tear duct can be uncomfortable but is manageable with early intervention. The plugs are inserted into the tear duct opening (punctal) in the corner of your eye. Some of these are specific to external DCR and others are specific to the endoscopic variety, but in general they all apply to both varieties. In most cases where the obstruction of the tear duct is in the nose, there is a 90% success rate. Chemo-Related Excessive Tearing and Blocked Tear Duct Surgery Complications. Subsequent tests include gentle syringing of a very small amount of salty water through the tear ducts to identify any narrowing or blockage of the tear drainage passages. Tear Duct Surgery An obstruction in the adult tear ducts may be caused by aging, trauma, inflammation from conditions like arthritis, certain medications, and tumors. Answer: Is tear duct cauterization wise? How is a blocked tear duct managed? Complications: dacryocystitis When I had the stent taken out, the tearing didn't get better. What part of the Body does the Procedure involve? He or she inflates and deflates the balloon a few times to open the blockage. Several chemotherapy drugs used during treatment – including Taxotere – have been shown to cause … Working endoscopically through the nose, our surgeons create a new opening for the tear duct to drain into the nose. Found insideDESCRIPTION An infected or blocked tear duct causes tears to gather or pool in ... POSSIBLE COMPLICATIONS A blocked tear duct may cause chronic infection. Blocked tear ducts are common in infants; as many as one third may be born with this condition. This surgical procedure eliminates the fluid and mucus retention in the lacrimal sac. Data abstracted from patient medical records included symptomatic relief and complications such as tube protrusion, infection, persistent bleeding and return to operating room. What can I do to manage my symptoms? Blocked tear ducts typically do not affect a baby’s vision, and there is no evidence that having blocked tear ducts as a newborn will cause future eye problems. Found inside – Page 499lacrimal problems, but the timing of repair is different [60]. ... Newer concepts of tear duct and eyelid anatomy and treatment. Trans Am Acad Ophthalmol ... I'm not an eye care professional. The easiest solution is to turn over to your other side so that the “good” eye or the eye that has had eye dacryocystorhinostomy (DCR) surgery is on top and you stay on the one side all night. In this book recent advances about the nasolacrimal ducts have been summarized and discussed in context with nasolacrimal duct pathophysiology. Tear Duct Surgery. This increases the eye's tear film and surface moisture to help relieve certain forms of dry eye.Also known as punctum plugs, lacrimal plugs or occluders, these devices often are no larger than a grain of rice. I had Endoscopic DCR (Tear Duct Replacement) surgery on September 13, 2011… it wasn’t a Friday. Even though this surgery is a simple procedure, it is accompanied by some complications such as: Bleeding; Infections; Permanent scars if the external technique is employed; The displacement of the stent if one is placed during the surgery; Tips for tear duct surgery recovery He flushed my tear duct & suggested DCR surgery. Clearing a blocked tear duct is a very common and safe procedure. An injury or trauma to the eye can also lead to a blocked tear duct. Once in the nose, tears are reabsorbed. First, the surgery is quick and easy. Punctal plugs are tiny, biocompatible devices that can be inserted into tear ducts to block drainage. Most blocked tear ducts heal on their own. Infection is very rare, but possible. Found inside – Page 238... while the flow of tears into the nasolacrimal duct is the passive process. 7.5.4 Complications Transcranial surgery has a long list of complications ... What part of the Body does the Procedure involve? A bile duct injury is damage to the bile ducts that happens during gallbladder surgery. The tear duct can be opened either endoscopically through the nose, or by an ‘open’ DCR which accesses the duct obstruction by making an incision along the nose. In a very serious life situation. Sinus surgery can also be used to biopsy masses for evaluation in the lab or for certain procedures involving the eye socket, including optic nerve decompression, orbital decompression, and dacryocystorhinostomy (used to create a new tear duct). * Concise text, showing all you need to know at a glance * Beautiful, clear, full colour pictures, illustrating the procedures involved * Step-by-step description of the most common lacrimal operations CONTENTS: Anatomy and embryology; ... Bile duct … Found inside – Page 39Saengpanich S, Kerekhanjanarong V, Chochaipanichnon L, Supiyaphun P. Nasolacrimal duct injury from microscopic sinus surgery: Preliminary report. It spends over $660 million a year on research and has more than 3,000 full-time research personnel. Whether you're in training or an established practitioner, Oculoplastic Surgery, a brand-new title in the Surgical Techniques in Ophthalmology Series, is your go-to manual for expert guidance on how to master new procedures, improve ... Tear-Duct Obstruction and Surgery. The primary goal of the surgery is to provide a pathway for tear drainage from the eye to the inside of the nose. This particular patient did very well after the first stage and went home the same day with little discomfort. Schaudig U(1), Maas R. Author information: (1)Universitäts-Krankenhaus Eppendorf, Hamburg, Germany. If you have poor quality tears or structural problems with your tear ducts, you may struggle to keep your eyes moist enough, which can lead to damage to your sclera, cornea, and other tissues. Tear Duct Probing. Then the doctor threads through the tear duct blockage in the nose a tube (catheter) with a deflated balloon on the tip. If this is determined to be the cause, dacryocystorhinostomy or DCR surgery is required to open it is. Second, there is very little likelihood of severe blood loss or severe complications. As with any surgery, scarring is possible; however, the skin wound typically heals well. The only way to solve these problems is to face them. Based on these concepts, this book incorporates new clinical and research developments as well as future perspectives in the ever-expanding field of rhinology. A leading cause of blocked tear ducts in adults is infection of the eyes, tear duct system, or nasal passages. As well as the complications of DCR described above, the following specific Lester Jones tube complications can occur: Air back-flushing into the eye with nose blowing (therefore these tubes are not suitable for patients who have CPAP for sleep apnoea) Mucous discharge from the nose to the eye Blockage of the tube Dacryocystorhinostomy (DCR) is a surgical procedure that involves restoration of the normal flow of tears through the tear ducts and alleviates the excessive tearing. Found inside – Page 255CHAPTER 13 COMPLICATIONS OF LACRIMAL SURGERY JOHN V. LINBERG Figure 13-2 . ... Nasolacrimal Duct Probing Complications that may occur from nasolacrimal duct probing include laceration of the punctum and canaliculus ... Found inside – Page 91From Surgery to the Avoidance of Complications Paraskevas Kontoes ... weak eyelid ligaments, certain autoimmune diseases, defects in the tear duct pathways, ... [1] Since that time, various materials have been used, including silk, nylon, polyethylene, and polypropylene. After tear drainage surgery, you may experience some bloody nasal discharge for several days. It should be dead last in the list. Some nasal bleeding can occur for 1-3 days after surgery but is usually minimal. Why is the Opening of Tear Duct surgical procedure Performed? To diagnose your condition, your doctor talks with you about your symptoms, examines your eyes and does a few tests. If your child's tear duct doesn't open on its own by age one, the doctor can do a … Your doctor will recommend a nasal decongestant spray, antibiotic ointment for the incision site, … All patients required dacryocystorhinostomy to achieve a patent lacrimal system drainage. That is when the plugs work a little too well and cause excessive tearing. Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. You may need surgery to open the tear duct if it does not get better without treatment. We treated eight patients with persistent nasolacrimal duct obstruction after endoscopic sinus surgery. The Mayo Clinic (/ˈmeɪjoʊ/) is a nonprofit American academic medical center focused on integrated health care, education, and research. Are There Any Risks From Tear Duct Blockage Surgery? So yes all came down to a DCR surgery . Most blocked tear ducts heal on their own. Then it drains into your nose. From there, tears travel down a duct (the nasolacrimal duct) draining into your nose. Tear drainage surgery/DCR has a low rate of complications. Sometimes the irrigation itself can remove the blockage and provide relief. In this incidence study, NDLO accounted for 31.8% of all chronic epiphora and 67.6% of all tear drainage pathway obstructions. When the nasolacrimal duct, the tube which drains tears into the nose, is blocked a surgical procedure is usually required. An infection within the “tear duct” causes a painful swelling in the inner corner of the eyelids. The procedure was easy, and thankfully painless. But all surgeries come with risks, including infection, bleeding, or problems with anesthesia. DCR (Dacryocystorhinostomy) is the surgical procedure used for the treatment of tear duct obstruction. During this procedure, called a DCR (Dacryocystorhinostomy), a hole is created between the tear sac and the inside of the nose. Tear drainage surgery/DCR has a low rate of complications. Often needs surgery: The tear duct is in the corner of the bottom eyelid near the nose and drains tears into the nose. I would have a stray tear or two roll down my cheek at random points throughout the day. To the best of my knowledge, most people do continue to tear until the stents are removed. Some patients suffer from nose bleeding (notice that a small bleeding of nose is … Refrain from blowing your nose for at least five days after surgery. The Johns Hopkins Hospital (JHH) is the teaching hospital and biomedical research facility of the Johns Hopkins School of Medicine, located in Baltimore, Maryland, U.S. The product liability lawyers at Hotze Runkle are leading the way when it comes to fighting for the rights of cancer patients and survivors who have been hurt by chemotherapy drug manufacturers. The most common treatment is gently milking or massaging the tear duct 2 to 3 times per day. Found inside – Page 118There are two approaches that can be used, each with different risks. An oculoplastic surgeon is the subspecialist to do this procedure. A small tear duct ... In more severe cases, your child may need surgery. Found inside – Page 13534Comment on : J Med Philos nasolacrimal duct obstruction : a preliminary report . ... lacrimal obstruction ( Suprascapular palsy : a complication of surgical ... Treatment of Tear System Blockage. Tear duct surgery is usually performed under general anesthesia in a team approach with an oculoplastics surgeon. Found inside – Page 54Even Song et al. decided not to recommend nasolacrimal duct stents as a first-line therapeutic option [37] although having achieved excellent initial ... Thus a new tear drain is created. Intranasal endoscopic sinus surgery has several potential ocular complications, including visual loss, diplopia, retrobulbar hemorrhage, and epiphora. A few problems can occur with punctal occlusion but the complications are rare. A bile duct can get cut, burned, or pinched. The primary goal of the surgery is to provide a pathway for tear drainage from the eye to the inside of the nose. Found inside – Page 61In the primary setting, disruption of the nasolacrimal duct may be managed by cannulation anastomosis and intubation of the lacrimal duct [Figs. Tear glands and tear ducts are the parts involved in the Opening of Tear Duct procedure. Treatment may require surgery and antibiotics to treat any associated infections. A nosebleed may occur on the affected side. Found inside – Page 172If a small tear occurs, these tend to close spontaneously with local wound care ... the nasolacrimal duct/canal can occur, especially if osteotomy design is ... The surgery that's commonly used to treat blocked tear ducts is called dacryocystorhinostomy (DAK-ree-oh-sis-toe-rye-nohs-tuh-me). This procedure opens the passageway for tears to drain out your nose again. First you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure. Dacryocystitis refers to an infection of the tear sacs, which are part of the tear drainage system in the eye. When the nasolacrimal (tear) duct becomes obstructed, a dacryocstorhinostomy (DCR) is often indicated. September 19, 2017. Wearing contact lenses or having a history of refractive surgery. It is also possible to displace the tube, which is inserted to keep the duct open and you may experience some bruising around the area of the operation. There are a couple of women who have posted journals about their recovery from DCR surgery- … This procedure is done under local anesthesia with sedation. Found inside – Page 363Patency of the lacrimal drainage system is verified by endoscopic observation of ... Duct Obstruction 363 Chapter 31 Surgical Results Surgical Complications. The patient is placed under local or general anesthesia and the surgeon then makes an incision and inserts a stent for drainage. Recovery takes about a week and, after several months, the doctor might remove the stent. The Mayo Clinic has an overview of blocked tear duct treatment. Third, there is no scar. Although it wasn’t terrible, I know that these things can become out of control if not dealt with as soon as possible. Blocked Tear Duct Surgery Tears usually drain through small openings in the corners of the eyelids, known as puncta, and enter the nose through the nasolacrimal duct. Before Surgery. Surgery Involving the Tear Duct. So I went to visit my general practitioner, and was referred to an ophthalmologist. The main risks of tear duct surgery are recurrence of the blockage (in about 10 percent of cases), infection (which is extremely rare), and blood from the eye or the nose. Should you be thinking about or intending to have eye DCR surgery, I recommend you ask the Ophthalmologist, eye specialist to not put in temporary stents. Found inside – Page 249... developed from angioplasty technology and applied to tear duct surgery. ... to the lower portion of the nasolacrimal duct and again to the Complications ... My mother had endoscopic DCR (tear duct surgery) two months ago. Tear duct surgery or Dacryocystorhinostomy (DCR surgery) involves the exploration and reconstruction of the tear ducts that normally drain tears from the ocular surface into the nose and mouth. I thought the stent was preventing the tears from getting through the tear duct, but I was wrong. Nasolacrimal stents are small diameter tubes placed within the nasolacrimal system to maintain patency. The duct may fill with fluid and become swollen, inflamed, and sometimes infected. How does the tear drainage system work? The incidence of NLDO is reported as 20.24 per 100,000. DCR Surgery. In this article we talk about surgery to open blocked tear ducts as next-step solution. The main risks of tear duct surgery are recurrence of the blockage (in about 10 percent of cases), infection (which is extremely rare), and blood from the eye or the nose. Infection, vision loss, and cerebrospinal (CSF) fluid leak are rare, but recognized, complications of surgeries performed in the medial canthal (inside corner of the eye and side of the nose) area. The text is lavishly illustrated with artwork and photographs, and supported by sample references. Tear duct cauterization is not at all outdated and can make the difference between miserable dry eye symptoms and comfort. when an enormous amount of swelling develops directly after the operation, such that, even after prying the eyes open, the vision is markedly reduced. This is the first book to cover all currently available methods to manage pre-, intra- and post-lacrimal sac stenosis. Comprehensive multidisciplinary approaches in adults and children are described. This impairs normal tear drainage, which may lead to infection. This is the story of my experiences having Dacryocystitis or a blocked tear duct. Heres a few pictures of each day as Sat was starting to taper down . He is a plastic surgeon/opthamologist. Found inside – Page 61LABOR LABORATORIES complications , umbilical cord , Spontane -Diagnostic chemistry as routine funcous tear of ... above sphincter during normal surgery , Smith ( S. 8b - 145 ) labor : Rouvé ( Ag . 3b - 203 ) LACRIMAL DUCTS instrumental ... If the tearing causes severe symptoms, surgery can be performed to create a new tear duct. As they sit more deeply in the duct, surgery … Found inside – Page 7Laser treatment of eye problems is available , and surgical corrections may include tear duct reconstruction and corneal transplants . He or she will also examine the inside of your nose to determine if any structural disorders of your nasal passages are causing an obstruction. This means 1 in 10 people may not improve after surgery. Etiology The practice specializes in treating difficult cases through tertiary care and destination medicine. Found inside – Page 488However, the risk appears to increase with increased total dose of radiation ... Epiphora, Canalicular Stenosis, and Nasolacrimal Duct Blockage Tearing in a ... Symptoms: acute onset, tearing (from nasolacrimal duct obstruction), redness, purulent discharge, tender swollen lacrimal sac. This book is designed to help Lacrimal surgeons not only avoid their own mistakes, but correct the complications of patients referred to them. Welcome to Blocked Tear Duct Surgery for Adults. DCR surgery should never be the first line of defense in epiphora treatment. Found inside – Page 376Nasolacrimal duct stent implantation was attempted in 19 patients with ... Eighteen stents were implanted in 17 patients without surgical complications. In some cases, the tear duct needs to be opened using a probe. The cancers in this location can go deeper and cause problems with … Lacrimal duct surgery complications and risks. As with any surgery, scarring is possible; however, the skin wound typically heals well. Most of the disadvantages of conventional DCR surgery are avoided. Introduction. Found inside – Page 311To prevent this complication , the back - biting forceps should be used ... Should the lacrimal duct be traumatized , no further dissection should be ... Duct Replacement ) surgery on September 13, 2011… it wasn ’ t fit properly could out... Posted journals about their recovery from DCR surgery- … April 5, 2015 procedure the... Getting through the tear ducts is called dacryocystorhinostomy ( DAK-ree-oh-sis-toe-rye-nohs-tuh-me ) should get worried about the procedure!, bleeding, or nasal passages dacryocstorhinostomy ( DCR ) is the opening of tear duct procedure is determined be... Duct itself will also assist patient did very well after the first described stent was of. Is lavishly illustrated with artwork and photographs, and nasolacrimal duct obstruction after endoscopic surgery! 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