Powered endonasal dacryocystorhinostomy: technique and results of a series of patients.

Abstract

Introduction: External dacryocystorhinostomy (DCR) has been the gold standard for treatment of epiphora. Currently several endoscopic DCR techniques are described. We evaluated results of endonasal DCR in our institution.

Methods: A retrospective chart review of a consecutive series of DCR procedures. Patients were subjected to a questionnaire a minimum of 6 months postoperatively to assess longer-term results.

Results: 19 DCR procedures in 16 patients (6 males) by a single surgeon (LD) were reviewed. Mean age was 60 (range 32 - 79). All patients suffered from epiphora (4-60 months), 7 had recurrent dacryocystitis. The technique involved the creation of a large rhinostomy using a microdebrider with a rough diamond burr and apposition of nasal mucosal and lacrimal sac flaps with Gelfoam. A silicone tube was placed in the nasolacrimal system. Patients were discharged day 1 and all patients reported immediate improvement of symptoms. Postoperative complications were limited to epistaxis in one patient. Patients were seen at week 1, 3 and 6 at clinic to perform suction cleaning until complete internal healing. The silicone tube was removed (at the last but one visit) after a median of 15 weeks (range 9-26 weeks) postoperatively. After a median follow-up of 19 months 13 patients were completely symptom free. Two patients reported minor symptoms sporadically. One patient reported recurrence of symptoms.

Conclusion: Powered endonasal DCR with internal marsupialisation of the lacrimal sac is a safe and successful procedure for the treatment of nasolacrimal duct obstruction.