Iatrogenic nasolacrimal duct obstruction: an unforeseen outcome of naso-orbito-ethmoid fracture surgery

Authors

  • Lim Yan Ru Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia; Department of Otorhinolaryngology- Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • Muhammad Hazim Abdul Ghafar Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
  • Kuhan Olakanathan Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
  • Salina Husain Department of Otorhinolaryngology- Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20261509

Keywords:

Nasolacrimal duct obstruction, Naso-orbito-ethmoid fracture, Computed tomography paranasal sinuses, Computed tomography dacryocystography, Silicone stent intubation

Abstract

Nasolacrimal duct obstruction can arise as a complication following naso-orbito-ethmoid (NOE) fractures, either due to bone fragments affecting the lacrimal apparatus or as a result of improperly placed implants during reconstructive surgeries. This case report describes a patient who underwent surgery for an NOE fracture with the placement of screws and plates, subsequently presenting with epiphora. The patient underwent endoscopic dacryocystorhinostomy (EDCR) without prior radiological imaging, and a screw was identified in the lacrimal bone during the procedure. Given that radiological imaging is not routinely conducted in all patients scheduled for EDCR, this report discusses the importance of preoperative imaging, particularly for patients with a history of orbital facial reconstruction. The potential benefits of prophylactic silicone stent intubation in patients with orbital facial injuries are also explored.

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References

Ha YI, Kim SH, Park ES, Kim YB. Approach for naso-orbito-ethmoidal fracture. Arch Craniofac Surg. 2019;20(4):219-22. DOI: https://doi.org/10.7181/acfs.2019.00255

Mohamad SH, Khan I, Shakeel M, Nandapalan V. Long-term results of endonasal dacryocystorhinostomy with and without stenting. Ann R Coll Surg Engl. 2013;95(3):196-9. DOI: https://doi.org/10.1308/003588413X13511609957939

Kondratishko E, Tjurina D, Bekers-Ancipolovskis M, Derovs A. Role of stenting in endonasal dacryocystorhinostomy: multiple challenges of the current approach. Proc Latv Acad Sci Sect B Nat Exact Appl Sci. 2022;76(6):578-84. DOI: https://doi.org/10.2478/prolas-2022-0090

Tomita K, Matsuyama H, Akimoto M. Two cases of nasolacrimal duct obstruction operated by endoscopic dacryocystorhinostomy after orbital fracture reconstruction with an implant. Am J Ophthalmol Case Rep. 2023;30:101853. DOI: https://doi.org/10.1016/j.ajoc.2023.101853

Wei J, Tang Z, Liu L, Liao X, Yu Y, Jing W. The management of naso-orbital-ethmoid (NOE) fractures. Chin J Traumatol. 2015;18(5):296-301. DOI: https://doi.org/10.1016/j.cjtee.2015.07.006

Mukherjee B, Gudkar AI, Nair AG, Poonam NS, Alam MS. Iatrogenic nasolacrimal duct obstruction after adnexal intervention: An avoidable consequence. Oman J Ophthalmol. 2021;14(3):157-61. DOI: https://doi.org/10.4103/ojo.ojo_462_20

Teoh RLW, Fong PY, Cai EZ, Yap YL, Hing ECH, Lee HJ, et al. Prophylactic intraoperative nasolacrimal duct intubation in surgical treatment of facial fractures—Is there a role?. Arch Plast Surg. 2022;49(2):195-9. DOI: https://doi.org/10.1055/s-0042-1744407

Choi SC, Lee S, Choi HS, Jang JW, Kim SJ, Lee JH. Preoperative computed tomography findings for patients with nasolacrimal duct obstruction or stenosis. Korean J Ophthalmol. 2016;30(4):243. DOI: https://doi.org/10.3341/kjo.2016.30.4.243

Lee KH, Han SH, Yoon JS. Case reports of lacrimal sac tumors discovered in patients with persistent epiphora following dacryocystorhinostomy. Korean J Ophthalmol. 2015;29(1):66. DOI: https://doi.org/10.3341/kjo.2015.29.1.66

Freitag SK, Roos JCP. Preoperative imaging should be performed prior to surgery in all cases of acquired nasolacrimal obstruction—Yes. Eye (Lond). 2016;31(3):351-2. DOI: https://doi.org/10.1038/eye.2016.237

Ali MJ, Singh S, Naik M, Kaliki S, Dave TV. Interactive navigation-guided ophthalmic plastic surgery: the utility of 3D CT-DCG-guided dacryolocalization in secondary acquired lacrimal duct obstructions. Clin Ophthalmol. 2016;11:127-33. DOI: https://doi.org/10.2147/OPTH.S127579

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Published

2026-05-25

How to Cite

Ru, L. Y., Ghafar, M. H. A., Olakanathan, K., & Husain, S. (2026). Iatrogenic nasolacrimal duct obstruction: an unforeseen outcome of naso-orbito-ethmoid fracture surgery . International Journal of Otorhinolaryngology and Head and Neck Surgery, 12(3), 417–420. https://doi.org/10.18203/issn.2454-5929.ijohns20261509

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Section

Case Reports