Diagnosis and treatment of lacrimal diseases

The laser is once again poised to revolutionize ophthalmology, this time in the realm of lacrimal surgery. Transnasal laser-assisted dacryocystorhinostomy is currently being evaluated as a less invasive method for lacrimal bypass surgery, and it certainly complies with the current trend toward outpatient procedures. Whether it can match the success rate of conventional dacryocystorhinostomy remains to be seen. Outpatient dacryocystorhinostomy with minimal complications is addressed in this review, emphasizing patient selection and preoperative evaluation, as well as avoidance of blood loss during the procedure, as the keys to success. Lacrimal surgery performed on patients with systemic diseases, such as osteopetrosis or Wegener's granulomatosis, presents a unique challenge, and this year, there has been a great deal of discussion about various stenting methods and a look at 25 years of experience with Jones tubes. A review of congenital dacryocystocele is presented along with advances in investigational techniques, such as lacrimal canaliculoscopy, combined computed tomography and dacryocystography, and ultrasound to evaluate patients preoperatively.