Transnasal endoscopic assisted dacryocystorhinostomy

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 1999

This prospective study was done ta compare the results of external and endonasal dacryocys-torhinostomy (DCR). 6 patients were studied under each group. Success rate for external DCR was 93.3% and endonasal was DCR 100%. The technique, merits and disadvantages of both the procedures are discussed as well as the advantages of endonasal DCR highlighted.

Journal of Evolution of Medical and Dental Sciences, 2017

BACKGROUND The conventional treatment of dacryocystitis is external dacryocystorhinostomy. Its success rate varies from 80-98%. 1-4 But patient's satisfaction was poor due to facial scar, disruption of medial canthus anatomy and dysfunction of lacrimal pump mechanism. Endoscopic DCR has neither facial scar nor any postoperative distortion of lacrimal pump mechanism and medial canthal anatomy. The objective of this study is to assess the surgical success rate and patient's satisfaction after endonasal endoscopic Dacryocystorhinostomy (DCR). Study Design-This study was done at Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, between January 2012 and August 2016. There were 34 patients included in this study. Females are more commonly affected than males. Unilateral cases are more than bilateral cases. Their age ranges from 13-83 years. Mean age is 35 years. MATERIALS AND METHODS Patients presented with epiphora or swelling below the medial canthus of eye with or without pain, mucopurulent regurgitation from the lacrimal sac into the eye on pressing the swelling. Five patients had concomitant deviated nasal septum, for which septoplasty was done along with DCR. The patency of nasolacrimal duct was assessed by syringing and diagnostic nasal endoscopy. RESULTS The success rate is comparable to other studies of endonasal DCR. The present study has a success rate of 97%. Advantages of endonasal DCR are: (1) There is no facial scar; (2) Preservation of lacrimal pump mechanism; and (3) Retention of medial canthal anatomy. CONCLUSION Endonasal endoscopic DCR overcomes all the drawbacks of external DCR and it is rapidly gaining recognition as a primary modality of treatment for dacryocystitis. Its success rate and patient's compliance rate are cent percent.

Bengal Journal of Otolaryngology and Head Neck Surgery

Introduction Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results, with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search. Materials and Methods In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was us...

Otolaryngology-head and Neck Surgery, 2007

To observe the benefit of endoscopic surgery for the treatment of lacrimal duct obstruction in revisional surgeries after external dacryocystorhinostomy. STUDY DESIGN AND SETTING: Retrospective nonrandomized study. Eleven cases of recurrent lacrimal duct obstruction after external dacryocystorhinostomy were submitted to endoscopic dacryocystorhinostomy.

Romanian Journal of Rhinology, 2015

OBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR.MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. ...

The Laryngoscope, 2000

Objective: Traditional endoscopic dacryocystorhinostomy (DCR) involves creation of a lacrimal sac side hole that may close down in the presence of a partially patent lower lacrimal drainage system. Endoscopic terminal DCR is a modified DCR procedure designed to prevent this problem. Methods: From September 1996 to June 1999, 16 patients (17 sides) had endoscopic terminal DCR that involved resection of the lacrimal sac-duct junction to achieve total separation of the lacrimal sac from the nasolarcrimal duct and creation of a terminal DCR opening. Results: Ten of the 17 DCRs were primary and 7 were revisions. The follow-up ranged from 3 to 36 months. There were two failures. One failure was due to canalicular obstruction and the other was due to prolapse of orbital fat hindering proper fashioning of the mucosal flap. The overall success rate was 88%. Conclusions: Instead of creating a side hole in the lacrimal sac as proposed by most endoscopic DCR studies, we advocate total diversion of tear flow by performing a terminal DCR opening that would further improve the success rate of endoscopic DCR, particularly in cases of idiopathic and partial obstruction.

Indian Journal of Otolaryngology and Head & Neck Surgery, 2010

The objective of present study was to compare the results of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. It was a prospective non-randomized study. Forty consecutive patients having complaints of watering with complete naso lacrimal duct obstruction were selected for the study. Dacryocystography was done in all the cases. Selection of type of operation was left to the patient's choice. All patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Twenty patients underwent endonasal dacryocystorhinostomy and twenty had external dacryocystorhinostomy. Silicon intubation was done in all cases of endonasal dacryocystorhinostomy for three months after surgery. The final follow-up was done at 12 months after surgery. The patency of lacrimal passage was confirmed by syringing and patients were questioned about their symptoms. There was no significant difference in the results of both surgeries. The complication rate in both groups was almost equal. Thus we came to the conclusion that these two different dacryocystorhinostomy techniques are acceptable alternatives.

Journal of Evidence Based Medicine and Healthcare, 2020

BACKGROUND Dacryocystorhinostomy (DCR) can be performed via two approaches either external approach or endonasally. Earlier, external approach was preferred but with the recent introduction of endoscopy, the focus has shifted to endoscopic DCR as it is a less invasive procedure. This study was conducted to compare both the approaches. METHODS 50 patients were selected from patients attending eye and ENT OPD of a medical college in Kolkata with complaints of watering and / or discharge or with other features of chronic dacryocystitis e.g., mucocele, pyocele etc. They were then allocated in to two groups, group A (patients who will undergo endo DCR) and group B (patients who will undergo external DCR). Results of both were compared. RESULTS The mean age of study population was 34.34 ± 6.65 yrs. Among the study population, 36 patients (72 %) were female and 14 were male (28 %). Mean age of Group A (i.e. patients subjected to endo DCR) was 34.60 ± 5.72, while that of Group B (patients u...

Applied Medical Research, 2015

Dacryocystography produces an image of the lacrimal sac and nasolacrimal duct (NLD) and is especially helpful in patients with suspected anatomic abnormalities like (a) congenital anomalies such as lacrimal sac diverticula and (b) patients who have had prior trauma (or) surgical procedures. Initial conservative dilation of the NLD having failed, the ophthalmologists were left with no option but to perform the conventional dacryocystorhinostomy (DCR), which requires an external incision resulting in a facial scar and is a long and fairly complicated procedure, requiring the use of operating microscope or loupes. DCR) is a surgical procedure done to drain the lacrimal sac in instances of intrasaccular and postsacular obstruction. Endonasal endoscopic DCR is now being performed as a primary procedure or for revision of failed cases of external this year. In this study, the efficacy of this procedure as a day case procedure and results of patients undergoing surgery with the 3 month follow-up are assessed. The study comprises the analysis of 20 patients of epiphora or chronic dacryocystitis who underwent endonasal endoscopic DCR within a period of 1 year. Based on the results, we concluded that endoscopic DCR is a simple, safe and minimally invasive procedure as it is a direct approach to the sac. It can be performed as a day case procedure under local anesthesia and excellent results. There is no need of routine systemic uncinectomy in all cases. Cosmetically, it is acceptable as there is no external scar.

Innovative Publication, 2016

Dacryocystorhinostomy (DCR) is an operation indicated for nasolacrimal duct obstruction. It creates a lacrimal drainage pathway into the nasal cavity to facilitate drainage of the previously obstructed excreting system. DCR can be performed either through external or endoscopic approach. We undertook this study to compare the results and advantages of endonasal endoscopic DCR with external DCR with respect to intraoperative and postoperative complications, duration of surgery, functional and cosmetic outcome. Out of 40 patients taken up for DCR, 20 underwent unilateral external DCR, 18 had unilateral endoscopic DCR and 2 had bilateral endoscopic DCR. Thus, a total of 22 eyes underwent endoscopic DCR and it was concluded that endoscopic dacryocystorhinostomy is a less time consuming, almost equally effective and aesthetically better then external approach and is an acceptable and functional alternative to external dacryocystorhinostomy.

Pakistan Journal of Medical Sciences, 2013

Objectives: To determine the outcome and complications of endoscopic dacryocystorhinostomy without stenting at Ziauddin University Hospital, Keamari, Karachi, Pakistan. Methods:Fifty Patients who underwent endoscopic dacryocystorhinostomy from Karachi were included.Data regarding the Outcomes and complications were collected and analyzed. Results:Among the 50 patients there were 38%(n=19) males and 62%(n=31) females.Their age ranged from 15 to 60 years, mean age was 43.54 ± 9.36 years. Majority of patients were in the age ranging from 31 to 50 years. The success rate after 6 months of surgery was 92% without any significant complications. Conclusion:Endoscopicdacryocystorhinostomy without stent is minimally invasive technique with less complications and good success state. In addition it gives no facial scar.

International journal of ophthalmology, 2014

To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy (END-DCR) or external dacryocystorhinostomy (EXT-DCR). Fifty patients who underwent EXT- or END-DCR between January 2010-2012 were involved in the study. A questionnaire was applied to patients preoperatively, and postoperatively. Subjective success was defined by absence of epiphora, objective success by a normal nasolacrimal lavage and a positive functional endoscopic dye test (FEDT). Postoperative pain and cosmetic result of surgery were interpreted by the patients, who were also asked whether they would offer this surgery to a friend or would prefer this surgery once more if necessary. Twenty-five patients underwent END-DCR and 25 underwent EXT-DCR. Mean duration of surgeries were 35min both for EXT-DCR (30-50) and END-DCR (35-50) (P=0.778). Intraoperative bleeding were documented in 48% of EXT-DCR and 4% of END-DCR cases (P<0.001). In total 96% of ...

International journal of health sciences

Background: Endoscopic dacryocystorhinostomy (DCR) has advantages like excellent homeostasis, absence of scar, less post operative pain and edema. However, less literature is available on success rate. Aim and objectives: To evaluate the success rate of endoscopic DCR. After 3 months DCR success rate was estimated based on relief perceived by the patient, free flow of saline on syringing through the lower canaliculus and presence of patent stoma visualized on rigid endoscopy. Materials and methods: 25 Epiphora patients underwent anterior rhinoscopy, nasal endoscopy, syringing, CT scan and DCR. They were evaluated for the relief of symptoms at 2 week and 3 month respectively. Results: Mostly 76% females with mean age (females:54.4/Males:59) were present. Symptoms: watering of eyes (100%), swelling (92%) and mucopurulent discharge (68%). Disease on the right side- 40% and left side -56% only 4% were with bilateral disease. On follow up after 3months 96% patients reported symptomatic ...

2012

To analyze endoscopic / endonasal dacryocystorhinostomy (endo DCR) cases regarding the problems encountered during the procedure, post operative complications, their management and success rate. Material and Methods: Endo DCR, done from Jan 2008 to Sep 2011 in eye departments of CMH Kharian and Mardan, were analyzed in this retrospective study. In the initial ten cases, only nasal packing with 5 cc of 2 % xylocaine with adrenaline 1:100000 mixed with 0.5 cc of adrenaline 1: 1000 was done and kept for fifteen minutes. In the next ten cases, after packing, injection of the same solution (2 cc of 2 % xylocaine with adrenaline mixed with 0.5 cc of adrenaline 1: 1000) was given at the operation site (sac area and middle turbinate) and packing was done again for ten minutes. In the rest of the cases, after packing, cautery was done instead of injection. In all the procedures, silastic intubation and application of mitomycin C, 0.5 mg/ml for ten minutes was done. Results: A total of 32 endo DCR operations were done in 31 patients (a three year boy had bilateral endo DCR) under general anesthesia. 3 were males and 28 were females. Age ranged from three years to sixty years (mean 42 ± 15). Follow up ranged from 6 to 10 months (7.5 ± 1.5). Problems arising during the operation included moderate bleeding in the nose obscuring view through the nasal endoscope during six operations (19%), difficulty in localization of sac area inside the nose in five operations (16 %), mild bleeding on first post operative day after two operations (6%) and persistent watering after five operations (16 %) which required revision. Revised cases were done with endonasal endoscopy and all improved except two. Conclusion: Problems / complications encountered during Endo DCR can be managed and the procedure has good success rate.

Documenta Ophthalmologica, 2002

Endoscopic dacryocystorhinostomy (EN-DCR) is a procedure that presents itself as an alternative choice to the conventional external approach. This study describes the results of endoscopic endonasal non-laser lacrimal surgery. We reported the data of 64 procedures of 63 patients with epiphora or chronic dacryocystitis who underwent primary EN-DCR by means of a microdrill or revision EN-DCR. One of these cases had bilateral surgery. There were 42 women and 21 men. Thirty-four cases had primary EN-DCR and 30 cases had revision EN-DCR secondary to previously failed external DCR. Mean follow up time was 11.34 months. The procedure was successful in 79.4% of primary EN-DCR cases and in 80% of revision EN-DCR cases. The overall success rate was 79.6%. Postoperative complications included periorbital edema, eyelid ecchymosis, punctal granuloma, cyst of the punctum, adhesion between the superior and inferior punctum. Tube dislocation occurred in 3 patients. Premature loss of silicone tube was determined in 5 patients and granulation tissue occurred at the internal osteum in 11 cases. EN-DCR, when compared with external dacryocystorhinostomy (EX-DCR), has lower success rate, but provides the potential advantages of better intraoperative hemostasis, and lack of cutaneous scar.