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In this technical variant, instead of seeking the lacrimal sac, the authors describe a retrograde technique. They first identify the nasolacrimal duct at the level of the most anterior insertion of the inferior turbinate in the lateral nasal wall. The thin bone overlying the duct is cracked by a blunt angled dissector and the duct identified (in some cases the bone can be quite hard and may need drilling). It is then followed upwards to positively locate the sac. The bone overlying the sac is then drilled and the puncta cannulated, and the sac is opened as usual. The authors conclude that this is a safe, quick and effective procedure. This seems a suitable technique in revision cases and in the presence of difficult anatomical conditions. However, they do not report on the complication rate, blood loss or inability to locate the duct.

Endoscopic “retrograde” dacryocystorhinostomy: A fast route to the lacrimal sac.
Alicandri-Ciufelli M, Russo P, Aggazzotti Cavazza E, Marton A.
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Badr Eldin Mostafa

Ain-Shams Faculty of Medicine, Almaza , Heliopolis, Egypt.

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