Abstract

Introduction: Obstruction of the nasolacrimal duct is a common disorder manifested by epiphora, purulent discharge from the eye or swelling in the lacrimal sac area. Dacryocystorhinostomy (DCR) is a procedure performed to drain the lacrimal sac in cases of nasolacrimal duct obstruction. Endoscopic DCR has many advantages over external DCR like avoidance of scar and preservation of lacrimal pump mechanism.

Objective: The aim of this study is to evaluate the success rate of endoscopic DCR in nasolacrimal duct obstruction by studying the symptomatic relief and patency of stoma of lacrimal sac after Endoscopic DCR and to study the factors influencing the surgical outcome.

Methods: A longitudinal study which spanned a period of 18 months. All the patients who underwent Endoscopic DCR were assessed at their post operative visit, at 1 week, 2 months and 6 months after surgery. At each visit, the symptoms of the patients were noted. Stoma was assessed by syringing and endoscopic evaluation.

Results: A total of 31 patients underwent endoscopic DCR of which 25 patients had primary acquired nasolacrimal duct obstruction (PANDO). 4 cases had secondary acquired nasolacrimal duct obstruction (SANDO) following multiple facial bone fractures and 2 cases were persistent congenital nasolacrimal duct obstruction. There were 14 patients with deviated nasal septum to the same side as that of DCR, but only 3 patients warranted a concomitant septoplasty. 28 out of 31 patients had good symptomatic relief and patent healthy stoma on follow up at 6 months. 3 cases were considered as failure. 1 case underwent revision surgery and is now asymptomatic. The other 2 failed cases were advised revision surgery, but declined and preferred observation.

Conclusion: Endoscopic DCR is an effective and safe surgical procedure with high success rate in the treatment of chronic nasolacrimal duct obstruction. Relevant concomitant sinonasal pathologies should be corrected to decrease the chance of failure. Regular follow up after endoscopic DCR is necessary. Early detection of stomal problems (by syringing and nasal endoscopy) and timely intervention will lead to a successful outcome

Keywords: Nasolacrimal duct obstruction, Endoscopic Dacryocystorhinostomy (DCR), Epiphora.