case_images: PMC9818678_01
case_images: Slit-lamp photos of both eyes. The height of the tear meniscus is approximately 0.3 mm on the right and 0.2 mm on the left. The right tear meniscus is higher than the left.
case_images: cop-2023-0014-0001-528637_f1.jpg
case_images: PMC9818678_01_cop-2023-0014-0001-528637_f1.jpg
case_images: F1
case_images: The tear meniscus height was slightly elevated in the right eye (Fig. 1).
case_images: A macroscopic image of the dacryoendoscope loaded with a sheath. We cut an 18-gauge catheter and used it as a sheath for the dacryoendoscope. The arrowhead is the part of the dacryoendoscope covered by the sheath. The part of the arrow can be pinched with a finger or forceps. When this part is held and moved, the sheath can be moved in front of the dacryoendoscope and the eyelashes can be moved while looking through the dacryoendoscope.
case_images: cop-2023-0014-0001-528637_f2.jpg
case_images: PMC9818678_01_cop-2023-0014-0001-528637_f2.jpg
case_images: F2
case_images: After expanding the punctum, a dacryoendoscopic probe with a sheath (Fig. 2) was inserted into the upper punctum.
case_images: Photograph of the inside of the lacrimal duct as seen through the dacryoendoscope. a The superior canaliculus was normal. b The internal ostium was blocked by a large number of eyelashes. The whitish debris was attached to the eyelashes. c No eyelash bundles were present from the lower lacrimal sac to the nasolacrimal duct, and the mucosa was normal. d The dacryoendoscope is surrounded by a sheath (arrowhead), which is shifted slightly forward and pushed and changed the direction of the eyelashes. e Some eyelashes (arrow) had become trapped at the blind end. The valve of Hasner was opened, and the sheath (arrowhead) and the eyelashes were pushed out into the nasal cavity (asterisk).
case_images: cop-2023-0014-0001-528637_f3.jpg
case_images: PMC9818678_01_cop-2023-0014-0001-528637_f3.jpg
case_images: F3
case_images: There was no abnormality in the canaliculi (Fig. 3a). The internal ostium was blocked by a large number of black, comb-shaped masses (Fig. 3b). No eyelash bundles were present from the lower lacrimal sac to the nasolacrimal duct, and the mucosa was normal (Fig. 3c). Using a dacryoendoscope with a sheath, the eyelashes were directed downward toward the nasolacrimal duct (Fig. 3d) which easily flowed through the lower opening under the pressure of the sheath and saline (Fig. 3e).