Purpose

To report a canaliculoplasty technique using direct visualization through a horizontal Horner’s muscle incision in cases with non-identifiable puncta or severe lacrimal canalicular obstruction.

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Methods

Two patients with epiphora and punctal obstruction underwent canalicular reconstruction. When puncta could not be identified, a horizontal incision at the mucocutaneous junction involving Horner’s muscle was used to explore the canaliculus under direct visualization, followed by silicone tube intubation.

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Results

Case 1: A 65-year-old man presented with bilateral epiphora and non-identifiable puncta. On the right side, both puncta were identified intraoperatively and intubated without canalicular obstruction. On the left side, the upper punctum could not be identified; therefore, canalicular exploration enabled localization of the lumen and successful intubation. A new punctum was created by suturing the canalicular stump, resulting in resolution of epiphora.
Case 2: An 82-year-old woman presented with acute dacryocystitis and orbital cellulitis. After intravenous antibiotics, endonasal dacryocystorhinostomy was performed. The inferior canaliculus was subsequently identified via horizontal Horner’s muscle incision and intubated. The tube was removed after two months, with no recurrence at six months.

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Conclusion

Direct visualization canaliculoplasty using a horizontal Horner’s muscle incision is a useful option when punctal identification is difficult and when there is a severe lacrimal canalicular obstruction, allowing reliable canalicular localization and satisfactory functional outcomes. This approach may offer a practical alternative to blind eyelid margin incision in selected cases.

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Additional Authors

First name	Last name	Base Hospital / Institution
Yasushi	Fujita	Oculofacial Clinic Group
Satoshi	Nakamura	Oculofacial Clinic Group
Ai	Minami	Oculofacial Clinic Group
Tomoyuki	Kashima	Oculofacial Clinic Group

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