Title: Efficacy of Endo Nasal DCR in Primary Nasolacrimal Duct Obstruction

Authors: Dr Sukhada Mishra, Dr Debabrata Panigrahi

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i5.96

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.

References

1.      Linberg JV, McCormick SA: Primary acquired nasolacrimal duct obstruction: A clinical pathologic report and biopsy technique: Ophthalmology,1986: 93:p 1055-63                

2.      Onerci M: Dacryocystorhinostomy; Diagn-osis and treatment of naso lacrimal canal obstruction: Rhinology:2002:40(2):p49-65

3.      Toti A: Nuovo methodo conservatore di cura radicale delle suppurazioni croniche del sacco lacrimale: Clin Mod Firenze: 1904: 10: p358-87.

4.      Tsirbas A, Davis G, Wormald PJ: Mechan-ical endonasal dacryocystorhinostomy; Ophthal Plast Reconstr Surg; 2004: 20(1):p50-56.    

5.      Hartikainen J, Antila J, Varpula M,Puukka P, Seppa H, Grenman R: Prospective randomized comparison of endonasal endoscopic  dacryocystorhinostomy and external dacryocystorhinostomy; Laryngoscope: 1998: 108(12),p 1861-66  

6.      Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD,Goldberg RA: External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral centre: Ophthalm-ology: 2005: 112(8)p1463-68.

7.      Ramakrishnan VR, Hink EM,Durairaj VD, Kingdom TT: Outcomes after endoscopic dacryocystorhinostomy without mucosal flap preservation; Am J of Rhinol; 2007; 21(6)p 753-57.

8.      Caldwell G: Two new operations for obstruction of the nasal duct ,with preservation of canaliculi and with an incidental descripton of a new lacrimal probe: Am J Ophthalmol;1893:10:p189-93

9.      Mc Donogh M, Meiring JH: Endoscopic trans nasal dacryocystorhinostomy: J Laryngol Otol: 1989: 103: p 585-87.

10.  Sprekelsen MB: Endoscopic dacryocysto-rhinostomy: Surgical techniques and results: Laryngoscope: 1996;106:p 187-89.

11.  Heikki S, Reidar G, Jouko H: Endo nasal CO2-Na: YAG Laser DCR: Acta Ophthalmological; 1994: 72: p703-706.

12.  Yung MN, Hardman Lea S: Analysis of the results of surgical endoscopic  dacryocystorhinostomy: effect of level of obstruction; Br J Ophthalmol; 2002: 86(7):p792-94.

13.  G C Sahoo, R Vasudevan, S Balaji, N M Arun: Endoscopic DCR for chronic dacryocystitis: A series of 50 cases: Odisha J of Otolaryngol and HNS; 2008,2(1):p25-27.

14.  AS Harugop, RS Mudhol, BK Rekha,  M Maheswaran:  Endonasal dacryocystor-hinostomy: A prospective study: Indian J Otolaryngol  Head Neck Surg; 2008; 60 p 335-340.

15.  N Moran,P Teron,J Dey: Role of Endonasal Endoscopic Dacryocystorhin-ostomy In Dacryocystitis; IOSR-JDMS,2015 , 14(4),P98-100.

16.  GC Gayen, KM Chowdhury, R Ray: Endoscopic endonasal dacryocystorhi-nostomy : Experience in a rural tertiary care hospital; IOSR J of Pharmacy: 2013, 3(4),p 01-04.

17.  Wormald PJ, Kew J, Van Hasselt A: Intra nasal anatomy of the nasolacrimal sac in endoscopic dacryocysto rhinostomy: Otolaryngol  Head Neck Surg:2000:123 (3):p307-310.        

18.  Khan MKH, Hossain MA, Hossain MJ, AL-Masud A, Rahman MZ: Comparative study of external and endoscopic endonasal dacryocystorhinostomy for the treatment of chronic dacryocystitis: JAFMC Bangladesh,20112 p15-17.

19.  Karim R, Ghabrial R,Lynch FF,Tang B: A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction; Clin Ophthalmol,2011,5, p979-89 .

20.  AK Dey, GC Gayen, S Jana, S Ghorai, A Sarkar, P Ganguly: External and endoscopic dacryocystorhinostomy in nasolacrimal duct obstruction: A comparative study: Int J of Health sciences & Research:,2014,4(12),P115-120.

21.  Durvasual VS, Gatland DJ: Endoscopic dacryocystorhinostomy: Long results and evolution of surgical technique: J of Laryngol Otol:2004:118(8): p628-32.

Corresponding Author

Dr Debabrata Panigrahi

Professor, Dept. of ENT, Institute of Medical sciences and Sum Hospital

Siksha ‘O’ Anusandhan University, K-8, Kalinga nagar, Bhubaneswar-751003, Odisha

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.; Tel: 09937406635