Abstract
Background & Objectives: Primary acquired nasolacrimal duct obstruction is the commonest cause of chronic dacryocystitis presenting with symptoms like epiphora, discharge, irritation and pain. Untreated cases leads to formation of dacryocele & fistula. External dacryocystorhinostomy (DCR) is the mainstay of treatment for this problem with a reasonable good success rate. But the external scar over the face, disruption of the lacrimal pump mechanism, injury to the medial canthal anatomy are the few pitfalls of the external DCR for which the endonasal DCR has been gaining popularity for last few decades. This study is undertaken to evaluate the efficacy of endonasal DCR in terms of successful outcome, intraoperative and postoperative complications.
Method: A prospective study was conducted on 84 patients of nasolacrimal duct obstruction with chronic dacryocystitis. All the patients were subjected to endoscopic endonasal DCR and followup was done for 6 months. Outcome of the surgery was measured by findings of the lacrimal passage irrigation & nasal endoscopy.
Result: The successful outcome noticed in 76 (90.4%) cases. Out of the 8 cases (9.6%) of failures 4 cases (4.8%) found to have granulations around the stoma,2 cases(2.4%) had mucosal overgrowth and another 2 cases(2.4%) had restenosis. Except injury to the lamina papyracea and prolapse of orbital fat in few cases (4.7%) no other major intraoperative complications were noticed in this series. Among the disadvantages adjunct procedures like septoplasty and conchoplasty were required in 27.3% & 13.1% of cases respectively.
Conclusion: Endoscopic Endonasal DCR is a valid alternative to external DCR. The succsess rate is similar and at the same time it avoids the pitfalls of external DCR. Intra operative complications are less. Learning curve is stiff due to requirement of few adjunct procedures.
Keywords: chronic dacryocystitis, nasolacrimal duct obstruction, dacryocystorhinostomy, endonasal dacryocystorhinostomy, DCR, endo DCR.
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DOI: https://dx.doi.org/10.18535/jmscr/v5i5.96
