Endoscopic dacryocystorhinostomy: personal experience

Introduction: Dacryocystorhinostomy (DCR) has been the standard procedure for acquired nasolacrimal duct obstruction. Lacrimal sac can be approached (1) Conventional External (Ex-DCR) or (2) Endoscopic (EN-DCR) Objective : To compare success rate , complication rate between the procedures Materials and Methods: Study design, prospective, interventional , clinical study was conducted in department of otorhinolaryngology in conjuction with ophthalmology,AMCH ,Duration of study : One year , from july 2011 to june 2012 , No. of cases : 60 cases(30 Endo-DCR,30 Ex-DCR) . Data were analysed by graphpad prism version 6.01 for Microsoft, Independent-sample t test &, chi square test with Yates correction was applied for comparison between groups , P value of <0.05 was considered stastically significant . Results and Observations : Total 60( 47 females,13 males) cases randomised into 30( 27females, 3males) endoscopic dcr, 30( 20females,10 males) external dcr, Mean age (32.367 )with range 18-55 yrs. in endoscopic dcr, Mean age (37.534 )with range 16-66 yrs. in external dcr. Present study shows success rate of 86.67% for En-DCR & 90% for Ex-DCR with P-value 0.557 CONCLUSION : The present study clearly shows that En-DCR is having results comparable EX-DCR ,

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.

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. ...

Clinical and Experimental Otorhinolaryngology, 2009

Results. Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%). Conclusion. In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.

Bengal Journal of Otolaryngology and Head Neck Surgery

Introduction Over last two decades endoscopic dacryocystorhinostomy has gained popularity over external dacryocystorhinostomy for post-canalicular obstruction. But the success rate is not very satisfactory. Our objective is to describe a technique where near 100% success can be achieved. Materials and Methods The study was conducted on 92 patients over 4 years and 6 months. The technique we describe involves creation of a large ostium, creation and apposition of nasal and lacrimal sac mucosal flaps. All the patients were under regular follow-up for12 months after operation. We also compared our result with other techniques. Results The neo-ostium was well healed and free flow of normal saline was seen in 90 cases (97.83%) post-operatively. In one case there was ostium fibrosis and in another case granulations were seen. Conclusion For the past few decades many approaches have been tried for endoscopic dacryocystorhinostomy. But the long term su...

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.

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.

JPMA. The Journal of the Pakistan Medical Association, 2021

OBJECTIVE To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy. METHODS The prospective cohort study was conducted at the Ophthalmology and Otorhinolaryngology departments, Shifa Foundation Community Health Centre, Islamabad, Pakistan, from October 2017 to September 2019, and comprised chronic dacryocystitis patients who underwent endoscopic endonasal dacryocystorhinostomy. Endoscopic dacryocystorhinostomy with or without lacrimal intubation was performed under general anaesthesia. The patients were followed up post-operative at 1 week, 1 month, 6 months and 12 months. Data was analysed using SPSS 20. RESULTS Of the 47 patients, 41(87.2%) were females. The overall mean age was 40.70±10.84 years (range: 25-66 years). Lacrimal intubation was performed in 31(66%) patients. Surgical success was achieved in 46(97.9%) patients. Of them, 37(78.7%) patients were completely symptom-free, while 9(19.1%) were partially symptomatic and were managed conservatively. Treatmen...

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.

Purpose. The aim of this study is to propose a simple and efficient combination surgery for the management of dacryocystitis with canalicular obstruction. Methods. A retrospective noncomparative case series of dacryocystitis with canalicular obstruction has been studied. Twelve patients with dacryocystitis and canalicular obstruction underwent a conventional endoscopic endonasal dacryocystorhinostomy (EE-DCR) combined with a modified canalicular repair. Postoperative observations included slit lamp, fluorescein dye disappearance test, lacrimal syringing, lacrimal endoscopy, and nasal endoscopy. Results. After 6-18 months of postoperative follow-up, the symptoms of epiphora and mucopurulent discharge disappeared completely in 10 patients, and occasional or intermittent epiphora remained in 2 patients. All of the twelve patients showed an opened intranasal ostium and normal fluorescein dye disappearance test. Patent bicanalicular irrigation was achieved in 9 patients. One patient had a partial and the other two had a complete reobstruction by lacrimal irrigation to their repaired lower canaliculus; however, all of them had a patent lacrimal irrigation to upper canaliculus. The functional success rate for the combination surgery is 83% (10/12), and anatomical success rate is 75% (9/12). Conclusion. EE-DCR combined with modified canalicular repair is a simple and efficient method for the management of dacryocystitis with canalicular obstruction.