Immediate Stentless Lacrimal Sac to Conjunctiva Reconstructive Ostomy for Cancer and Trauma Defects: LACROS (Conjunctivodacryocystostomy).

Abstract

Purpose: To describe and evaluate the efficacy and safety of lacrimal sac to conjunctiva reconstructive ostomy for proximal lacrimal system reconstruction.

Methods: This retrospective study included 41 patients (32 cancer and 9 trauma; 36 primary and 5 secondary) who underwent lacrimal sac to conjunctiva reconstructive ostomy. The technique involves creating a direct connection between a surgical opening in the lacrimal sac, which maintains its bony attachments to prevent ostomy occlusion, and the medial conjunctiva (medial fornix, bulbar, and palpebral). Interrupted 7-0 polyglactin 910 sutures were used to form a 3- to 5-mm-diameter lined conduit. Stenting was not employed. When necessary, oral mucosa or mucoperiosteal grafts and local flaps were utilized for reconstruction. Outcomes were assessed by epiphora prevention, the functional patency of the lacrimal ostomy, and the patient-reported nasolacrimal duct obstruction symptom score.

Results: On examination, all patients demonstrated canalization of the lacrimal sac to the conjunctival reconstructive ostomy, as evidenced by unobstructed tear drainage. Complications occurred in 17% of cases, including periorbital edema, chemosis, diplopia, and conjunctival granuloma. The average nasolacrimal duct obstruction symptom score for lacrimal-ocular symptoms was 3.1/10 and for nasal symptoms was 2.3/10 (0 best, 10 worst). Tearing was the least prominent complaint (0.8/10), with 1 patient reporting permanent tearing (6/10).

Conclusion: Lacrimal sac to conjunctiva reconstructive ostomy proves to be a valuable procedure for immediate and delayed proximal lacrimal system reconstruction in cancer and trauma cases due to its straightforward and stent-free approach and its favorable 8-year outcomes.