I perform dcr through the endoscopic approach, 95% of the times. Endoscopic dacryocystorhinostomy endonasal dcr surgery can be performed to create a functioning tear drainage system where there is an obstruction to the tear duct causing a watery eye. Jan 29, 2004 in 4 cases, the endoscopic dcr was associated with an osteocartilagineous septoplasty 3 of which endoscopically. Clinical experience suggests that endoscopic lacrimal surgery offers technical benefits over the traditional external approach that. Does longterm success from endoscopic dcr correlate with early postoperative reduction in tearing am j. Specific focus included the identification of unanticipated pathologic findings as they related to pertinent patient demographics, clinical presentation, radiologic. Mar 23, 2017 advantages of endoscopic dcr it provides better aesthetic result with no external scar. Mar 14, 2017 the nice benefit of the endoscopic approach is the avoidance of a facial scar. Inferiorly, the inferior turbinate is demonstrated. Endoscopic dcr a good alternative procedure, but not the new standard.
Endoscopic dacryocystorhinostomy edcr is a wellestablished surgical procedure with results that are equivalent to the classic open approach. Endoscopic dcr surgery blocked tear duct surgery by dr. We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy endo dcr in patients treated in the leaning position and under local anesthesia with minimal sedation las. Sep, 2017 endoscopic dcr surgery blocked tear duct surgery by dr. Questionnaire to determine subjective success of endo dcr. The key to the improved success rates achieved with endoscopic dcr is to attempt to replicate the external procedure as closely as possible.
Endoscopic dacryocystorhinostomy dcr is a surgical intervention for epiphora caused by obstruction of the nasolacrimal duct. Understanding endonasal anatomy, wide endoscopic marsupialisation of the lacrimal sac, and meticulous care of the nasal mucosa are important to achieve good results. Mean operating time was lowest for balloon dcr mean sd, 27. An endoscopic dacryocystorhinostomy abbreviated as end dcr, an operation performed for an obstruction in the nasolacrimal duct, is undertaken through the. It allows a onestage procedure to also correct associated nasal pathology that may be causative. In 4 cases, the endoscopic dcr was associated with an osteocartilagineous septoplasty 3 of which endoscopically. Endoscopic dcr is performed through your nostrils and does not result in any facial scars or change to the outside shape of your eyelid or nose. A dcr procedure involves removal of bone adjacent to the nasolacrimal sac and incorporating the lacrimal sac with the lateral nasal. There is a learning curve involved with the endoscopic technique, and it is best performed by an experienced. Dacryocystorhinostomy dcr is a procedure utilized for symptomatic acquired nasolacrimal duct obstruction nldo due to stenosis of the nasolacrimal duct or, less commonly, dacryoliths. Jul 28, 2017 a modified preserved nasal and lacrimal mucosal flap technique in endoscopic dacryocystorhinostomy. Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about. A couple of times id rub my eye and the loop would expand so id just smush it back in place. A large study that compared the use of lasers with electrocautery instruments for endoscopic dcr in 398 patients reported success rates of 92% 222242 and 90% 2831 using two different laser types, and 87% 3945 for.
Thirtyfive patients were included in this study, and selection of patients was done depending on both clinical findings preoperatively and on the operative findings during surgery. Overview endoscopic dacryocystorhinostomy guidance nice. Nasolacrimal duct dysfunction has many different etiologies. These results are similar to those achieved with external dcr8,9. The histopathology of nasolacrimal specimens n 769, obtained from 654 consecutive patients undergoing endoscopic dcr by a single surgeon over a 30. Basic technique and keys to success learning objective upon completion, participants should be able to. Mehryar ray taban, md tabanmd beverly hills oculoplastics surgery 2,125 views.
We evaluated the tolerability and efficacy of endoscopic dacryocystorhinostomy endodcr in patients treated in the leaning position and under local anesthesia with minimal sedation las. Exdcr was first described by toti in 1904 and is the most widely practiced procedure. The diagnosis is clinical, so a thorough clinical history and. Adequate removal of bone during procedure is the only root for success for surgery. This video displays a left sided endoscopic dcr with lit pipette assistance for a 25 year old patient with severe epiphora and. The nice benefit of the endoscopic approach is the avoidance of a facial scar. However, there is an abundance of nonrandomized studies suggesting that endoscopic dcr with the mechanical removal of bone is a viable alternative to external dcr, with comparable outcomes. Ophthalmic surgical devices to treat retinal detachment, cataract, dry eye, repair ptosis. Total 111 dcr surgeries 55 exdcr, 56 endcr, were performed on 106 primary nldo patients, including 5 bilateral endcr. However, its distal end has been shown to be occluded by a membrane in 73% of otherwise normal stillborn fetuses at term. After 12 months, 59% 1932 of patients were asymptomatic. Does longterm success from endoscopic dcr correlate with early postoperative reduction in tearing am j otolaryngol. Endo dcr, done from jan 2008 to sep 2011 in eye departments of cmh kharian and mardan, were analyzed in this retrospective.
Conventional dacryocystorhinostomy versus endonasal. Original article problems complications, success rate. Dacryocystorhinostomy dcr failures may occur after primary external or endoscopic approaches. Jun 10, 2008 endoscopic dcr a good alternative procedure, but not the new standard. Nldo is common, and presenting symptoms include epiphora and dacryocystitis infection. Nov 30, 2011 so in laser dcr endoscopic guidance is must, difference is of knife. Results of endoscopic dacryocystorhinostomy under local. However, on closer endoscopic examination there is a fold within the lacrimal sac 108. Endoscopic ultrasonic dacryocystorhinostomy for recurrent. Endoscopic dacryocystorhinostomy e dcr is a wellestablished surgical procedure with results that are equivalent to the classic open approach.
Powered endoscopic dacryocystorhinostomy with mucosal flaps. Nonetheless, outcomes comparable to the external technique were only reached when we started removing the bone and achieving full exposure of the lacrimal sac 15,16. Access is through your nose, using a small thin camera endoscope. The basic indication is same in all cases and either route can be used. Compared with external dcr, endoscopic dcr is more expensive, with high equipment costs. Endoscopic dacryocystorhinostomy dcr endoscopic dacryocystorhinostomy dcr is indicated for patients with lacrimal sac obstruction or nasolacrimal duct obstruction nldo. The role of routine nasolacrimal sac biopsy during endoscopic. Powered endoscopic dacryocystorhinostomy with mucosal.
The operation is very similar to external dcr, except there is no cut through the skin and no scar afterwards. The endoscope is introduced into the left nares where the middle turbinate and middle meatus are noted. It preserves the pumping mechanism of the orbicularis oculi ms active infection of the lacrimal system. Experience with endoscopic dacryocystorhinostomy using four. Apr 22, 2019 endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. Comparison of external and endoscopic dacryocystorhinostomy. Rates for success for endoscopic dacryocystorhinostomy dcr ranges from 70% 4 to 95%5,6,7. Most of the studies conducted of endoscopic dcr have a recorded a success rate of around 80%7, 8, 9, 10 which is lower than external dcr success rate of which are around 90%11, 12, 14. Oct 04, 20 despite much debate, many still believe that external dcr provides a high success rates than endoscopic dcr though many types of endonasal approaches have been attempted, long term success rates are less than ext.
Endoscopic dcr eye lid surgery tear drainage surgery. Javate papers on endoscopic radiofrequency assisted dacryocystorhinostomy eradcr and endoscopic lacrimal duct recanalization eldr published in both the journal of surgical technique in ophthalmic plastic and journal of reconstructive surgery and ophthalmic plastic reconstructive surgery. Describe the basic steps of endoscopic dacryocystorhinostomy. Dec 22, 2015 dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. At 6 months after surgery, the overall anatomical and functional success rate was 90. Your surgeon will make cuts in the lining of your nose close to where the tear duct should enter your nasal cavity. At first glance the ostium appears large and patent. However, with all the advantages endoscopic dcr provides it is essential to develop a technique which could increase the success rate of this surgery. This video demonstrates an endoscopic dacryocystorhinotomy dcr. Endoscopic dacryocystorhinostomy the first series of endonasal endoscopic procedures were published in the late 80s and early 90s 1214. A decongestant is administered to clear the nasal passage first and then gauze, soaked with anaesthesia that numbs the area and constricts blood. Endoscopic surgery of the orbit and related structures 7. Revision surgery is beneficial for many of these patients.
All procedures were performed under general anaesthesia, by one surgeon l. Questionnaire to determine subjective success of endodcr. Comparing outcomes of the standard technique of endoscopic. They will remove some bone so they can see the lacrimal sac. Endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. In operations 30% a septoplasty was required at the time of surgery, and in 10 operations 23% further endoscopic sinus surgery was performed in conjunction with the dcr. Endoscopic ultrasonic dacryocystorhinostomy for recurrent dacryocystitis following rhinoplasty nadia k. Dacryocystorhinostomy dcr surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora water running down the face. Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about differences. So in laser dcr endoscopic guidance is must, difference is of knife. Anatomical variation of sac is dependent on anatomy of lateral wall of nose which is the sole reason of direct visualization under endoscopic guidance helps in achieving 100% success. Mean age for exdcr and endcr was 5217years, 3618years. Two main advantages are quicker recovery and lack of external scar. Surgical outcomes of endoscopic dacryocystorhinostomy.
Endoscopic dcr is also technically more difficult to learn, and there is a definite learning curve. Endoscopic dcr is a minimally invasive procedure performed by ophthalmologists and otorhinolaryngologists to unblock tear ducts and correct other causes of decreased patency of the nasal passages. Jun 21, 2012 dacryocystorhinostomy dcr surgery can be done from external approach or endoscopic though the nose approach. Endoscopic dcr endoscopic dcr is a minimally invasive procedure to unblock tear ducts. Based on the only randomized controlled trial, external dcr provides a superior outcome to endoscopic dcr with regard to symptoms at 1 year follow. Revision endoscopic dacryocystorhinostomy sciencedirect. Endonasal endoscopic and external dcr approaches have their own advantages and disadvantages. Clinical experience suggests that endoscopic lacrimal surgery offers technical benefits over the traditional external approach that may aid in revision cases. To analyze endoscopic endonasal dacryocystorhinostomy endo dcr cases regarding the problems encountered during the procedure, post operative complications, their management and success rate. Endoscopic dcr is not the new standard for nasolacrimal duct surgery. The diagnosis is clinical, so a thorough clinical history and physical. All the patients underwent endoscopic dcr with silicon stent placement.
Dcr is also used for congenital nldo when probing and irrigation, silicone intubation, or balloon catheter dilatation has failed. They both have equal success assuming done by experienced surgeons. This video displays a left sided endoscopic dcr with lit pipette assistance for a 25 year old patient with severe epiphora and pain from chronic dacrocystitis and dacryolith. Dacryocystorhinostomy dcr surgery can be done from external approach or endoscopic though the nose approach. Editor,canalisation of the nasolacrimal apparatus usually occurs at the same time throughout its length. Although the aim of surgery is to create a direct communication between the lacrimal sac and the lateral wall of the nose by drilling out the lacrimal bone, different endoscopic surgical techniques to the lacrimal sac are possible. A modified preserved nasal and lacrimal mucosal flap technique in endoscopic dacryocystorhinostomy. This video shows the endoscopic revision of a patient with late failure of an endoscopic dcr. Role of silicon stent in endoscopic dcr international. It can be done with external ex or endonasal en access. Conclusion standard endoscopic dcr and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction.
Right lateral wall of the nasal cavity in an anatomical specimen presenting the inferior turbinate it, middle turbinate mt, superior turbinate st and supreme turbinate sut. It avoids injury to the medial canthus scar formation. I have to have a dacrocystorhinostomy after a rhinoplasty. A modified preserved nasal and lacrimal flap technique in. Dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. Dcr is also used for congenital nldo when probing and irrigation, silicone intubation, or. The key to the improved success rates achieved with endoscopic dcr is to attempt to. From may 20 to august 2014, a total of 95 eyes with epiphora presented to the myoung eye. I commented before about the discomfort of the tubing.