Specific features of endoscopic dacryocystorhinostomy – case report

AbstractOBJECTIVE. 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. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later. CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct obstruction.

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Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1314 ◽

2017 ◽

Vol 10 (2) ◽

pp. 86-90

Author(s):

Aditya Kashyap ◽

Satisg Negi ◽

Prem L Chauhan ◽

Kuldeep Thakur

Keyword(s):

Operative Time ◽

Nasal Endoscopy ◽

Functional Evaluation ◽

Lacrimal Sac ◽

Endoscopic Dacryocystorhinostomy ◽

Group I ◽

Chronic Dacryocystitis ◽

Endoscopic Dcr ◽

Fluorescein Dye

ABSTRACT Objective To compare the results of conventional nasal endoscopic dacryocystorhinostomy (DCR) and inferior nasal endoscopic DCR in Study cases of idiopathic chronic dacryocystitis. Materials and methods Forty patients diagnosed with idiopathic chronic dacryocystitis were divided into two groups alternately. After relevant investigations, they were subjected for endoscopic DCR by two techniques. Twenty patients underwent conventional endoscopic DCR and 20 underwent inferior endoscopic DCR under transoral pterygopalatine block and topical lignocaine (4%) with adrenaline 1:2,000. After 3 months of follow-up in the outpatient department, nasal endoscopy along with fluorescein dye disappearance test (FDDT) at 10 minutes was done. Results Ninety-five percent (19/20) of patients undergoing conventional endoscopic DCR and 90% (18/20) of patients undergoing inferior endoscopic DCR were found to have patent anatomical fistula. On FDDT, nasal endoscopy after 10 minutes revealed 84% (16/19) in group I and 94.4% (17/18) in group II with fluorescein in nasal cavity. Conclusion Present study concludes the importance of bony, tendinous, and muscular support of lacrimal sac in physiological lacrimal pump functioning and advantage of relatively new technique of inferior endoscopic DCR. Inferior endoscopic DCR is associated with less operative time as well as less local complications. How to cite this article Thakur K, Kashyap A, Negi S, Chauhan PL. Anatomical and Functional Evaluation of Conventional vs Inferior Endoscopic Dacryocystorhinostomy in Study Cases of Idiopathic Chronic Dacryocystitis. Clin Rhinol An Int J 2017;10(2):86-90.

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Canaliculitis masquerading as Dacryocystitis: Rhinologist's Dilemma

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1315 ◽

2017 ◽

Vol 10 (2) ◽

pp. 91-92

Author(s):

Sima Das ◽

Nishi Gupta ◽

Neeraj Chawla

Keyword(s):

Correct Diagnosis ◽

Nasolacrimal Duct ◽

Purulent Discharge ◽

Delay In Diagnosis ◽

Lacrimal System ◽

Chronic Dacryocystitis ◽

History Of ◽

Endoscopic Dcr ◽

Nose And Throat ◽

Punctal Plug

ABSTRACT Aim To highlight canaliculitis masquerading as chronic dacryocystitis that may mislead a rhinologist. Background Canaliculitis is an inflammation of the lacrimal canaliculi caused by infection or as a complication of punctal plug insertion. It is often misdiagnosed, leading to a delay in diagnosis. Case report We report a case of a 20-year-old female patient who presented with complaints of watering from left eye since 1 year and was referred to the Department of Ear, Nose, and Throat for endoscopic dacryocystorhinostomy (DCR). She had a history of silicone punctal plug insertion in the same eye for “dry eye” following an attack of herpes zoster 12 years earlier. She was asymptomatic for 10 years following punctal plug insertion, but started complaining of epiphora since the last 2 years. Punctal plug was removed 1 year back by an ophthalmologist but the epiphora persisted. Regurgitation of purulent discharge on pressure over lacrimal sac area made it look like dacryocystitis. Syringing through lower punctum was blocked while through the upper punctum it was patent. Thus, possibility of nasolacrimal duct block was ruled out. An occuloplasty opinion was sought and a diagnosis of lower canaliculitis with possibility of retained plug was made. Conclusion Canaliculitis should be considered as a differential diagnosis in cases presenting with epiphora as canaliculitis is a close masquerade of dacryocystitis. Clinical significance As more and more rhinologists are getting direct referrals of cases needing endoscopic DCRs, it is important for them to be well aware of other associated pathologies of proximal lacrimal system. This will help them to reach a correct diagnosis before going ahead with endoscopic DCR. How to cite this article Gupta N, Das S, Chawla N. Canaliculitis masquerading as Dacryocystitis: Rhinologist's Dilemma. Clin Rhinol An Int J 2017;10(2):91-92.

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Efficacy of mitomycin c in endoscopic dacryocystorhinostomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20184355 ◽

2018 ◽

Vol 4 (6) ◽

pp. 1431

Author(s):

Vinod Shinde ◽

Anju Unnikrishnan ◽

Shad Fatma ◽

James Thomas

Keyword(s):

Mitomycin C ◽

Nasolacrimal Duct ◽

Lacrimal Sac ◽

Duct Obstruction ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy ◽

Nasal Sprays ◽

Group I ◽

Chronic Dacryocystitis ◽

Cause Of Failure

Background: Endoscopic dacryocystorhinostomy is a procedure done to drain the lacrimal sac due to post saccular lacrimal obstruction. The most common cause of failure of dacryocystorhinostomy is blockage of ostium created in lacrimal sac. Various methods are employed to prevent the blockage such as stenting, mitomycin C and steroidal nasal sprays. In this study we evaluated the efficacy of mitomycin C in reducing the stomal closure following dacryocystorhinostomy.Methods: Fifty patients who were diagnosed with chronic dacryocystitis due to nasolacrimal duct obstruction were chosen for the study. They were randomly divided in to two groups. In group I 25 patients under went endoscopic dacryocystorhinostomy with intraoperative mitomycin C application and in group II 25 patients underwent endoscopic dacryocystorhinostomy without application of mitomycin C. Patients were followed up at the end of one week, three weeks, three months and six months. Surgical success was evaluated objectively at the end of six months. Results: The success rate of endoscopic dacryocystorhinostomy with use of mitomycin c was 86% in group where mitomycin c was used and 62% in group where mitomycin c was not used.Conclusions: Mitomycin C is a safe drug which can keep the stoma created patent and reduces the chance of recurrence following endoscopic dacryocystorhinostomy.

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Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1284 ◽

2016 ◽

Vol 9 (3) ◽

pp. 120-124 ◽

Cited By ~ 6

Author(s):

MM Rajshekar

Keyword(s):

Controlled Trial ◽

Nasolacrimal Duct ◽

Stent Insertion ◽

Stent Group ◽

Excessive Bleeding ◽

Endoscopic Dacryocystorhinostomy ◽

Secondary Hemorrhage ◽

Significant Difference ◽

Endoscopic Dcr ◽

Endoscopic Picture

ABSTRACT Aim To study surgical outcome in dacryocystorhinostomy (DCR) stent insertion in initial endoscopic DCR and the complications associated with the surgery. Study design This is a prospective, single-blinded, randomized, controlled trial. Materials and methods The study was carried in a tertiary level center (period between November 2009 and February 2015). A total of 50 patients with epiphora due to nasolacrimal duct obstruction were divided randomly into two groups – with one group undergoing endoscopic DCR with stent and the other group undergoing endoscopic DCR without stent. The postoperative results were assessed subjectively and objectively after 3 and 6 months and also for complications of the procedure. The results were statistically analyzed by chi-square test. Results There was significant postoperative improvement across all participants and within both groups. A total of 92% of patients in the stent group and 84% of patients in the without stent group improved. There was no significant difference with respect to complications. Synechiae and secondary hemorrhage were the most common complications in the without stent group and stent group respectively. Conclusion The present study shows that statistically significant difference in results is not achieved by inserting stents initially. But, whenever there is excessive bleeding during surgery, which masks endoscopic picture, or when bony stoma created is small because of thick bone and poor access, when atrophic sac is present, or when adhesions are expected due to pus in sac, then stenting should be done without hesitancy. Best time to do stenting is when surgeons’ first think of stenting. Regular postoperative follow-up is necessary as any defect like synechia and granulation tissue formation can be dealt with immediately. How to cite this article Rao SVM, Rajshekar MM. Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy. Clin Rhinol An Int J 2016;9(3):120-124.

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Endoscopic Dacryocystorhinostomy: Advantage over External Approach

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i2.244 ◽

2019 ◽

Vol 27 (2) ◽

pp. 161-166

Author(s):

Bijan Basak ◽

Kaustuv Das Biswas ◽

Subhradev Biswas ◽

Ankit Choudhary

Keyword(s):

Standard Treatment ◽

Nasolacrimal Duct ◽

External Approach ◽

Interventional Study ◽

Safe Alternative ◽

Endoscopic Dacryocystorhinostomy ◽

Chronic Dacryocystitis ◽

Endoscopic Dcr ◽

Prospective Longitudinal ◽

External Dcr

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 used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature. Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

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A New Modification in Endoscopic Endonasal Dacryocystorhi̇nostomy Scopy-Guided Approach

10.21203/rs.3.rs-307225/v1 ◽

2021 ◽

Author(s):

Akalın İrfan ◽

Ahmet Kalkışım ◽

Hasan Gündoğdu

Keyword(s):

Surgical Intervention ◽

Nasolacrimal Duct ◽

Silicone Tube ◽

Endoscopic Endonasal ◽

New Approach ◽

Surgical Success ◽

Endoscopic Dacryocystorhinostomy ◽

Significant Difference ◽

Endoscopic Dcr ◽

Anatomical Success

Abstract PurposeTo compare and assess classic endoscopic dacryocystorhinostomy (cEDCR) and scopy-guided endoscopic dacryocystorhinostomy (sEDCR) which is a new approach we developed in cases of primary nasolacrimal duct obstruction (PNLDO).MethodsFifty eyes (7 in both eyes) of 43 patients who applied with epiphora and underwent endoscopic DCR and silicone tube implantation between 2015 and 2019 were prospectively studied. cEDCR was performed on 26 of 50 eyes, and sEDCR was performed on 24 of 50 eyes. In sEDCR application, 5 cc non-ionizing opaque material was injected after punctum dilatation, lateral oblique radiographs were taken from the obstructed side with C-arm scope, and the size and location of the lacrimal sac were made visible. Thence, the most appropriate part of the passage was visualized, and surgical intervention was made through this point. Patients were followed in day 1, week 1, 3rd and 6rd mounth. Functional success was assessed according to Munk scoring, and anatomic success was assessed with nasolacrimal lavage. Two groups were compared according to surgical success, time, and complications.ResultsMean age of the cases were 47.85 (±11.8) in the cEDCR group and 54.29 (±16.23) in the sEDCR group. Female and male gender distribution was 21 (80.8%) - 5 (19.2%) for cEDCR and 15 (62.5%) - 8 (37.5%) for sEDCR, respectively. Functional success was spotted as 92.3% in the cEDCR group and 95.8% in the sEDCR group (p:1.0); anatomical success was spotted as 88.5% in the cEDCR group, and 95.8% in the sEDCR group (p:0,611). There was no significant difference between two groups. Mean surgery time was 43 minutes in the cEDCR group and 48 minutes in the EDCR group. Complications were minor and rare (p >0.05). ConclusionAs we are aware of that, our study is the first in literature in which scopy is used in endoscopic DCR. In our study, the sEDCR approach is assessed as a useful modification which improves success and facilitates surgery.

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Successes rate of endoscopic dacryocystorhinostomy at KMC

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i2.3557 ◽

1970 ◽

Vol 8 (2) ◽

pp. 195-198 ◽

Cited By ~ 2

Author(s):

S Shrestha ◽

PK Kafle ◽

S Pokhrel ◽

M Maharjan ◽

KC Toran

Keyword(s):

Success Rate ◽

Symptomatic Relief ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Sinus Surgery ◽

Duct Obstruction ◽

Complete Cure ◽

Endoscopic Dacryocystorhinostomy ◽

Endoscopic Dcr ◽

Sac Syringing

Background: Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. Objectives: The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. Materials and methods: A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. Result: In six months' follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. Conclusion: Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR. Key words: Nasolacrimal duct; Epiphora; Rigid nasal endoscope; Endoscopic Dacryocystorhinostomy DOI: 10.3126/kumj.v8i2.3557 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 195-198

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Role of Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Comparative Study

International Journal of Advanced and Integrated Medical Sciences ◽

10.5005/jp-journals-10050-0002 ◽

2016 ◽

Vol 1 (1) ◽

pp. 4-6 ◽

Cited By ~ 2

Author(s):

Shahzad Ahmad ◽

Bhawana Pant

Keyword(s):

Comparative Study ◽

Nasolacrimal Duct ◽

Endoscopic Dacryocystorhinostomy ◽

Medical College ◽

Randomized Design ◽

Silicone Stent ◽

Foreign Body Reactions ◽

Endoscopic Dcr ◽

The Cost

ABSTRACT Objective To evaluate the role of using silicone stent in endoscopic dacryocystorhinostomy (DCR) and compare the results with endoscopic DCR without silicone stenting. Design Prospective study, interventional type, randomized design and comparative analysis. Materials and methods The study was done in Department of Otorhinolaryngology, Government Medical College and Dr Susheela Tiwari Hospital, Haldwani, Uttarakhand. We included 30 patients in the study presenting with epiphora with or without mucocele and congenital cases of dacryocystitis and nasolacrimal duct (NLD) blockage were included in the study. All patients were divided into two groups. First one undergoing endoscopic DCR and silicone stent was used in all cases and second one underwent endoscopic DCR and no stent was used. Postoperative assessment was carried out at the end of 1st, 3rd, 6th and 10th week and the role of silicone stent was subjected to compare. Result Use of silicone stent was not improving the results and risk of failure of the surgery had increased with stent due to granulation formation in the lacrimal sac region. Apart from that, foreign body reactions in the form of irritation, pain were seen with stent. It also added the cost of surgery without giving much benefit to the patient. How to cite this article Ahmad S, Pant B. Role of Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Comparative Study. Int J Adv Integ Med Sci 2016;1(1):4-6.

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Effectiveness of Primary Monocanalicularnasal Intubation With Monoka Tubes and Nasal Endoscopic Findings for Congenital Nasolacrimal Duct Obstruction With Enlarged Lacrimal Sac and Chronic Dacryocystitis

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e31825dad6c ◽

2012 ◽

Vol 23 (6) ◽

pp. 1638-1641 ◽

Cited By ~ 7

Author(s):

Hwa Lee ◽

Jaemoon Ahn ◽

Hyung Ho Shin ◽

Minsoo Park ◽

Sehyun Baek

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Lacrimal Sac ◽

Congenital Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Endoscopic Findings ◽

Chronic Dacryocystitis

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Endoscopic dacryocystorhinostomy: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20163476 ◽

2016 ◽

Vol 2 (4) ◽

pp. 254 ◽

Cited By ~ 2

Author(s):

Jyothi A.C. ◽

Ajay Kumar ◽

Prawahar Chiluveru

Keyword(s):

Neck Surgery ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Research Centre ◽

Surgical Removal ◽

Lacrimal Sac ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Medical College ◽

Frontal Process

Background: The purpose of the study was to determine the outcome and safety of endoscopic dacryocystorhinostomy (ENDO-DCR) with the use of silicon stents in nasolacrimal duct obstruction.Methods: This study was done in the department of otorhinolaryngology and head and neck surgery, Navodaya Medical College and Research Centre, Raichur, from January 2013 to June 2015, with a total of 82cases (10 cases with bilateral disease) underwent a standardized procedure, with an endonasal approach to the lacrimal sac, surgical removal of nasal mucosa, lacrimal bone, and a fragment of the frontal process of the maxilla. The medial wall of the lacrimal sac was removed completely and canalicular silicone intubation tube was placed for six weeks post operatively. Main outcome measures were resolution of epiphora, absence of discharge, and patency of the ostium confirmed by irrigation and endoscopic evaluation of neo osteum at 6 weeks.Results: The ENDO-DCR procedure with adjunctive canalicular silicon intubation tube was successful in 78 (95%) cases. No significant complications were encountered during or after operative periodConclusions: Endoscopic dacryocystorhinostomy with canalicular silicon intubation for shorter duration (6 weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction in adults as well as in children with a success rate of 95%.

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