Endoscopic Dacryocystorhinostomy (DCR): a team approach

Abstract

Aim: Endoscopic transnasal dacryocystorhinostomy (DCR) has recently increased in popularity as it has advantages over the traditional external DCR in that no external incision is required, the medial canthal ligament is not disturbed and the pump action of the orbicularis oculi muscle is not disrupted. The surgery is performed endoscopically through the nose with assistance provided from the eye. The surgical technique is presented in detail. 

Materials and methods: In the 29 consecutive patients who underwent this procedure, 3 (10%) required septal surgery for adequate exposure of the operative site. There were 26 patients who had primary DCRs and 3 patients who had revision DCRs. 

Results: The overall success rate was 84% (24 out of 29) with 2 failures in the primary DCR group and 1 in the revision DCR group. Complications were minor with 3 epistaxis, 1 orbital fat exposure and 1 minor corneal abrasion. 

Conclusion: The ophthalmologist and otolaryngologist provide different but equally important skills in this procedure. The ophthalmologist is best placed to diagnose nasolacrimal duct obstruction while the otolaryngologist diagnoses potential predisposing conditions such as sinusitis and anatomical variants that may need to be dealt with at the time of surgery. The surgery is a combined procedure with the otolaryngologist exposing the lacrimal sac endoscopically and the ophthalmologist confirming the site and size of the sac and tenting the sac wall for incision. The ophthalmologist also places silastic tubes should this be required. This team work optimizes the success of endoscopic DCR.