Abstract

Aim: This study was undertaken to compare the success rates of external DCR with external DCR combined with bicanalicular intubation of the lacrimal drainage apparatus.

Material and Methods: A total of 28 eyes of 28 patients were selected for this study, 15 patients were selected for conventional external DCR the rest 13 patients were selected for conventional DCR combined with bicanalicular silicone tube intubation. Silicone tubes were between 20 - 22 G. Patients ranged from 26 years to 71 years in age. Factors such as recurrent chronic dacryocystitis, fistula formation and mucocoele were taken into account. None of the eyes had any history of nasolacrimal surgical intervention.  Eyes were randomly included in both the subgroups. The group with intubation were left with the silicone tubes in situ for 2 months. These eyes were followed up for a period of 18 months, initially weekly for one month after intervention, then monthly for two more months and then three monthly till end of study period.

Results: 18 females and 10 males in a total of 28 patients were operated. External dacryorhinocystostomy combined with bicanalicular intubation could not be performed in 1 patient. One patient had a spontaneous expulsion of the silicone tube at 2 weeks post intervention. At three months post intervention 13 out of 15 eyes having conventional DCR had remained patent, a success rate of 86.67% where as 11 out of 12 eyes in the group having external DCR combined with intubation had remained patent, this gives a success rate of 91.67%. However at 6 months post intervention the conventional external DCR group presented 12 patent eyes ie, a success rate of 80.0% and the other group, ie, external DCR with combined intubation still had 10 patent eyes, ie, a success rate of 83.33%, further at 12 months post intervention the conventional external DCR group had a success rate of 73.33%, the combined intubation with external DCR (ex-DCR) group had a success rate of 83.33%. At the end of the study period of 18 months conventional DCR recipients had a success rate of 68% (10/15 eyes). The second group on the other hand had a success rate of 75.0 % (9/12 eyes). It was found that the age of the patient and the laterality of the eye did not influence outcome, male sex had higher rates of failure.

Conclusions: It was found out that success rates in the conventional external DCR group was lower than that of ex-DCR with intubation group moreover the  presence of complications such has recurrent dacryocystitis, and presence of bony deformities like mild deviated nasal septum (DNS) further lowered the success rates.  In conclusion it can be said that although external DCR is the gold standard in chronic dacryocystitis, the success rates are significantly increased when it is combined with silicone tube intubation, especially in complicated cases. Furthermore this neither significantly increases the cost of surgery nor require any expensive instruments or special training.

Keywords: External Dacryocystorhinostomy, Intubation-DCR, failed DCR, Deviated Nasal Septum.