Lacrimal Injury During Endoscopic Sinus Surgery: Avoidance and Management

A 41-year-old female was referred to our rhinology service after prior endoscopic sinus surgery. Her medical history was significant for chronic rhinosinusitis and allergic rhinitis. Postoperatively, she developed left-sided epiphora that did not resolve for 2 months and had persistent symptoms related to rhinosinusitis. Endoscopic examination revealed an injury to the left nasolacrimal duct at the level of the head of the middle turbinate. This was confirmed on computed tomography scan, which also demonstrated ongoing sinus inflammation. Evaluation by the ophthalmology service demonstrated nasolacrimal duct obstruction during lacrimal irrigation. After a discussion of treatment options, the patient proceeded with endoscopic dacryocystorhinostomy and revision sinus surgery, which resolved the epiphora and other symptoms.