Tools and methods for dacryocystorhinostomy

Abstract

A dacryocystorhinostomy (DCR) tool (10) includes a perforating shaft (30) having a distal perforating tip (32) configured to form a bypass between a lacrimal sac and a nasal cavity through a lateral side of the lacrimal sac, a lacrimal bone, and nasal mucosa. A DCR guide (20) includes a nasal guide component (40) configured to be inserted into the nasal cavity and having a distal guide tip (42); and a lacrimal guide component (50) shaped so as to define a guide channel (52) that orients the DCR guide (20) with respect to the distal perforating tip (32) during advancing of the distal perforating tip (32) through a lacrimal passageway and into the lacrimal sac, until contact of the distal perforating tip (32) with the distal guide tip (42) blocks further advancing of the distal perforating tip (32). The DCR guide (20) constrains the distal guide tip (42) to fall in a path of advancement of the distal perforating tip (32). Other embodiments are also described.

1 . An apparatus comprising:
 a nasal component configured to be inserted into the nasal cavity, the nasal component having a distal tip;   a lacrimal guide channel;   a perforating shaft configured for being received within said lacrimal guide channel, said perforating shaft having a distal perforating tip configured for advancing through a lacrimal passageway, to form a bypass between a lacrimal sac and the nasal cavity; and   a dacryocystorhinostomy (DCR) guide coupled to said nasal component and to said lacrimal guide channel, wherein said DCR guide is configured to orient said distal tip of said nasal component relative to said distal perforating tip during said advancing of said distal perforating tip, to block advancing of said distal perforating tip beyond said distal tip.   
     
     
         2 . The apparatus according to  claim 1 , wherein the DCR guide is configured to set a desired angle between respective central longitudinal axes of the nasal component and the perforating shaft. 
     
     
         3 . The apparatus according to  claim 2 , wherein the DCR guide is shaped so as to define an arcuate portion comprising (i) a first support member coupled in fixed orientation to said nasal component, and (ii) a second support member coupled in fixed orientation to said lacrimal guide channel, wherein said first and second support members are arranged in slidable attachment with respect to one other so as to set a total aggregate length of said arcuate portion, and wherein said total aggregate length of said arcuate portion defines said desired angle. 
     
     
         4 . The apparatus according to  claim 1 , wherein said lacrimal passageway includes a lacrimal punctum, a lacrimal canal, and a common canaliculus. 
     
     
         5 . The apparatus according to  claim 1 , wherein the nasal component, including the distal tip, is shaped so as to define a nasal guidewire-accepting channel, and wherein said nasal guidewire-accepting channel comprises a distal opening which faces at least partially in a lateral direction that faces toward the lacrimal guide channel. 
     
     
         6 . The apparatus according to  claim 5 , wherein the nasal component comprises (a) an outer guide element that is shaped so as to define a nasal-shaft-accepting channel therethrough, and (b) a nasal shaft that is slidable through the nasal-shaft-accepting channel, and wherein the nasal shaft is shaped so as to define the distal tip and the nasal guidewire-accepting channel. 
     
     
         7 . The apparatus according to  claim 6 , wherein the perforating shaft, including the distal perforating tip, is shaped so as to define a lacrimal guidewire-accepting channel. 
     
     
         8 . A method comprising:
 providing an apparatus comprising:
 a nasal component configured to be inserted into the nasal cavity, the nasal component having a distal tip, 
 a lacrimal guide channel, 
 a perforating shaft configured for being received within said lacrimal guide channel, said perforating shaft having a distal perforating tip configured for advancing through a lacrimal passageway, to form a bypass between a lacrimal sac and the nasal cavity, and 
 a dacryocystorhinostomy (DCR) guide coupled to said nasal component and said lacrimal guide channel, 
 wherein said DCR guide is configured to set a desired angle between respective central longitudinal axes of the nasal component and the perforating shaft, and to orient said distal tip of said nasal component relative to said distal perforating tip during said advancing of said distal perforating tip, to block advancing of said distal perforating tip beyond said distal tip; 
   inserting said nasal guide into said nasal cavity;   operating said DCR guide to set said desired angle; and   advancing said perforating shaft through said lacrimal passageway to form said bypass, until said advancing is blocked by said distal tip.   
     
     
         9 . The method according to  claim 8 , wherein the DCR guide is shaped so as to define an arcuate portion comprising (i) a first support member coupled in fixed orientation to said nasal component, and (ii) a second support member coupled in fixed orientation to said lacrimal guide channel, wherein said first and second support members are arranged in slidable attachment with respect to one other so as to set a total aggregate length of said arcuate portion, and wherein said total aggregate length of said arcuate portion defines said desired angle. 
     
     
         10 . The method according to  claim 8 , wherein said lacrimal passageway includes a lacrimal punctum, a lacrimal canal, and a common canaliculus. 
     
     
         11 . The apparatus according to  claim 8 , wherein the nasal component, including the distal tip, is shaped so as to define a nasal guidewire-accepting channel, and wherein said nasal guidewire-accepting channel comprises a distal opening which faces at least partially in a lateral direction that faces toward the lacrimal guide channel. 
     
     
         12 . The apparatus according to  claim 11 , wherein the nasal component comprises (a) an outer guide element that is shaped so as to define a nasal-shaft-accepting channel therethrough, and (b) a nasal shaft that is slidable through the nasal-shaft-accepting channel, and wherein the nasal shaft is shaped so as to define the distal tip and the nasal guidewire-accepting channel. 
     
     
         13 . The apparatus according to  claim 12 , wherein the perforating shaft, including the distal perforating tip, is shaped so as to define a lacrimal guidewire-accepting channel. 
     
     
         14 . An apparatus comprising:
 a nasal component configured to be inserted into the nasal cavity, the nasal component having a distal tip, wherein the nasal component, including the distal tip, is shaped so as to define a nasal guidewire-accepting channel;   a lacrimal guide channel; and   a lacrimal guidewire shaft configured for being received within said lacrimal guide channel, the lacrimal guidewire shaft having a distal shaft tip configured for advancing through a lacrimal passageway, wherein the lacrimal guidewire shaft, including the distal shaft tip, is shaped so as to define a lacrimal guidewire-accepting channel, and   a dacryocystorhinostomy (DCR) guide coupled to said nasal component and said lacrimal guide channel,   wherein said DCR guide is configured to orient said distal tip of said nasal component relative to said distal shaft tip during said advancing of said distal shaft tip, to block advancing of said distal shaft tip beyond said distal tip.   
     
     
         15 . The apparatus according to  claim 14 , wherein said distal shaft tip is configured to form a bypass between a lacrimal sac and the nasal cavity. 
     
     
         16 . The apparatus according to  claim 14 , wherein the DCR guide is configured to set a desired angle between respective central longitudinal axes of the nasal component and the lacrimal guidewire shaft. 
     
     
         17 . The apparatus according to  claim 16 , wherein the DCR guide is shaped so as to define an arcuate portion comprising (i) a first support member coupled in fixed orientation to said nasal component, and (ii) a second support member coupled in fixed orientation to said lacrimal guide channel, wherein said first and second support members are arranged in slidable attachment with respect to one other so as to set a total aggregate length of said arcuate portion, and wherein said total aggregate length of said arcuate portion defines said desired angle. 
     
     
         18 . The apparatus according to  claim 14 , wherein said nasal guidewire-accepting channel comprises a distal opening which faces at least partially in a lateral direction that faces toward the lacrimal guide channel. 
     
     
         19 . The apparatus according to  claim 14 , wherein the nasal component comprises (a) an outer guide element that is shaped so as to define a nasal-shaft-accepting channel therethrough, and (b) a nasal shaft that is slidable through the nasal-shaft-accepting channel, and wherein the nasal shaft is shaped so as to define the distal tip and the nasal guidewire-accepting channel. 
     
     
         20 . The apparatus according to  claim 14 , wherein said lacrimal passageway includes a lacrimal punctum, a lacrimal canal, and a common canaliculus.