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To evaluate if 0.04% MMC application at the ostium enhances the outcome of non-endoscopic endonasal dacryocystorhinostomy (NEED) in individuals with primary acquired nasolacrimal duct obstruction (PANDO)

Due to the limited sample size and the single-center setting, the statistical power for detecting adverse events was relatively low

Evaluation may include history, physical exam, inflammatory markers, autoimmune labs, metabolic assessment, and functional medicine testing when appropriate.

Duodenal fistula leaking through skin defect and still open duodenal defect at 2 weeks following fistula creation by anastomosis between the skin and duodenum defect ( c )

Do not remove and re-insert the needle multiple times, as each puncture creates a potential contamination pathway