The uncinate process is attached anteriorly to the bone around the nasolacrimal duct and if a middle meatal antrostomy is extended too far anteriorly the lacrimal sac or nasolacrimal duct is damaged (Fig. 12.23 a, b). The best way to avoid this is to not enlarge the ostium anteriorly. If the middle meatus needs to be enlarged anteriorly to allow improved access or drainage, then the uncinate process is best removed retrogradely with back-biters. If the back-biters require anything other than minimal force to remove the uncinate process, then it is likely that the bone around the na-solacrimal duct is also within the jaws of the biters and you should not continue to grip the instrument. If a patient complains that their eyes are watering in the days after surgery, it is best not to intervene as it will often resolve of its own accord. If epiphora persists, an endonasal dacryocystorhinostomy will resolve the problem.

Nasolacrimal Duct Cadaver
Fig. 12.23 Epiphora due to damage to the right nasolacrimal duct (a) shown on CT scan (b).
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