Khalid Mahida

Associate professor Otolaryngology

Mohammad Ayub Bhatti

Assistant Professor Ophthalmology

Ziauddin University Karachi

Overview

It is procedure used to create a lacrimal drainage pathway in to nasal cavity to reestablish the permanent drainage of obstructed excretory system

External Dacryocystorhinostomy

Endoscopic Laser assisted DCR Endoscopic Transnasal or Endonasal

Non laser Punch removal of bone Powered instruments Mucosal flap Preservation

Endoscopic DCR

Is a commonly performed operation in which a fistulous tract is created between the lacrimal sac and the nasal cavity in order to relieve the epiphora due to nasolacrimal duct obstruction

 Epiphora

caused by anatomic or functional lacrimal sac or nasolacrimal duct obstruction dacryocystitis with purulent drainage from the canaliculi

Chronic

 It

provides a better aesthetic result with no external scar. allows a one-stage procedure to also correct associated nasal pathology. avoids injury to the medial canthus.

It

It

It preserves the pumping mechanism of the orbicularis oculi muscle.

infection of the lacrimal system is not a contraindication to surgery. is especially superior to the external approach in revision surgery

Active

It

 The The

perioperative time is shorter.

success rate is comparable to the external approach.

 Specialized

surgery.

training in nasal endoscopic

The

endoscopic equipments are expensive as compared to External DCR

 Epistaxis. Orbital

fat may be exposed.

Damage

to the medial rectus and superior oblique may cause diplopia.

 Epistaxis Infection

in the nose or orbit

Adhesions Pyogenic

granulomata at the site of rhinostomy

Opthalmological examination ENT examination Hematology Biochemistry Dacryocystography

25

20

15

10

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

Male Female

12 32

Unilateral Bilateral

41 03

Epiphora Purulent Discharge Medial canthal Swelling Nasal Symptoms Deviated Nasal Septum

44

03 19
10

16

Negative Externel DCR Syringing and probing

35 09 43

Hypertension and DM

03

General Anesthesia Application of 1:1000 Adrenalin pack Xylocain Adrenaline Injection to Lateral Nasal wall 20-gauge fiberoptic endoilluminator Incision and elevation of Mucosa Punch Removal of Bone and Medial wall of Lacrimal sac

Adhesions None

05 39

Symptom free Mean duration

39 8.5 months

19%

89%

Symptomatic Relief

1st Week
Complete Relief Partial relief No relief

2nd Week

6th week

10th Week

EnDCR without stenting is effective for the treatment of naso-lacrimal duct obstruction. This procedure gives good anatomic and functional results, with low complication rates. In the present series of 44 consecutive procedures, a functionally patent dacryocystorhinostomy was achieved in 39 cases without the need for nasolacrimal stent insertion. Taking into account the added cost and potential morbidity, we suggest that the use of nasolacrimal stents, in EnDCR, can be avoided.