Endoscopic ultrasonic dacryocystorhinostomy for recurrent dacryocystitis following rhinoplasty

Mostovych NK, Rabinowitz MR, Bilyk JR, Pribitkin EA.

What this paper says

A single case report describes repeated tear sac infection after a first rhinoplasty, treated by creating a new tear drainage channel through the nose with an ultrasonic bone tool, with no symptoms at 18 months.

Overview

The tear sac sits behind the bone at the side of the nose and is the structure most at risk when the nasal bones are cut during rhinoplasty. If the cut is made low and to the side, or along the frontal process at the frontal maxillary suture, the medial canthal tendon can tear and the tear sac beneath it can be injured. This report follows one patient in whom that injury led to repeated infection.

Sections of note

Single case report from one institution, graded level of evidence 5.
The complication was dacryocystitis after primary rhinoplasty, which recurred.
Repair was endoscopic dacryocystorhinostomy, done through the nostril without an external scar.
Bone was removed with a Sonopet ultrasonic bone aspirator.
The result was a patent nasolacrimal duct, with the patient still symptom free at 18 months.
The authors state this is the first reported case of recurrent post rhinoplasty dacryocystitis treated this way.

What it means for a patient

Persistent tearing, swelling or infection at the inner corner of the eye after rhinoplasty can signal injury to the tear drainage system.
A blocked tear duct after nose surgery can be reopened through the nostril, with no facial incision.
This is one patient with follow-up to 18 months, so it shows the repair is possible, not how often it succeeds.
The abstract reports no complication rate for the repair and no comparison with other treatments.

Why this paper matters

Osteotomy position determines whether the lacrimal system is at risk, so this case reinforces where the cut should sit. It leaves open how common the injury is and which repair method works best when it happens.

Terms

Dacryocystitis: infection of the tear sac at the inner corner of the eye.
Dacryocystorhinostomy: an operation that makes a new drainage path from the tear sac into the nose.
Osteotomy: a planned cut in bone, used in rhinoplasty to narrow or straighten the nose.
Medial canthal tendon: the band anchoring the inner corner of the eyelids to bone.
Nasolacrimal duct: the tube that carries tears from the eye into the nose.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“The lacrimal sac is the structure most vulnerable to injury when performing rhinoplastic osteotomies. When performed in a low lateral position or along the frontal process of the frontal-maxillary suture, osteotomies can potentially tear the medial canthal tendon and injure the underlying lacrimal sac, possibly…”

Excerpt; the full abstract is on PubMed.