Endoscopic Dacrocystorhinostomy: A Pakistani Experience

Abstract

Purpose: To surgically create a new passage for the lacrimal fluid to flow into the nose from the eye using the endoscopic technique.

Material and Methods: Endoscopic dacrocystorhinostomy (DCR) was performed on selected patients (n=16) using a 4mm zero and 30 degree nasal endoscope and a camera system .The puncta dilated with punctum dilator and probing done before passing a light probe by ophthalmologist to enter the lacrimal system while the ENT surgeon created a window medial to the lacrimal sac through bone and into the sac via the corresponding nostril. Silicon (Jones) tubes were used as stents and left in situ for six months. A regular follow up plan continues till eight months.

Results: Seven males (43.8%) and nine females (56.3%) under went endoscopic DCR with their ages ranging from 10 to 67 years. All patients had epiphora, mostly in the left eye (43.8%). Out of all, 37.5% of the patients had a deflected nasal septum towards the side of surgery while only 6.3% (septoplasty or SMR) had to have their septum corrected before DCR could proceed. Only two patients needed trimming of their middle turbinates to make more room for surgery. Allergic rhinitis was common (25%) and so were itchy eyes (50%).All patients were relieved of their symptoms postoperatively (100%) two months post removal of the silicon tubes.

Conclusion: DCR should be done endoscopically now which gives no facial scars and is a safe and effective procedure (in the hands of an experienced surgeon) with a low morbidity and mortality. However, formal training is mandatory.