• External DCR – gold standard for NLDO
compared to endonasal or transcanalicular
DCR
• Aim – consider factors affecting success of
DCR
• Inclusion criteria – chr.dacryocystitis,
mucocele, epiphora.
• Exclusion criteria - < 10yrs, nasal pathology,
lid laxity, canalicular obstruction.
Lacrimal drainage disorders
•
•
•
•
Chronic dacryocystitis (59)
Lacrimal fistula (1)
Mucocele (1)
Previous failed DCR(1)
Age and sex distribution
males
No. of patients
<40yrs
1
40yrs-85yrs
6
females
<40yrs
15
40yrs-85yrs
40
Total
62
Surgical procedure
• Large osteotomy
• Suturing of anterior flaps
• Silicon tube intubation
Anterior Nasal Mucosal Flap
Sac Mucosal Flap
Silicon Intubation Tube
Silicon Tube Knotted
Knotted Silicon Tube Outside The External Nares
Nasal and Sac Mucosal Sutured
Silicon Intubation Tube Seen In The Puncta
Intraoperative complications
Bleeding from incision site
2
Bleeding from nasal mucosa
8
Inappropriate place and size of osteotomy 0
Difficulty fashioning the mucosal flaps
1
Intraoperative bleeding
% of cases
study
27.5%
Mirzaman etal
13%
Adravani etal
6.2%
Gazemund K
0.6%
Akhund
16.2%
Present study
Late postoperative complications
scar
4
Conjunctival irritation by tube
2
Non patency
1
Punctal/canalicular tear
0
Post operative complications
• Scar very faint - acceptance
• complications like migration of tube, rupture
of central thinner segment, slitting of
punctum – not found.
Postoperative results
patent
Non patent
At 6 months (silicon tube
removed )
61
1
At 1 year
61
1
• 98% success
• Success – resolution of symptoms like
epiphora and discharge & a patent lacrimal
system on irrigation.
• Silicon intubation facilitates epithelialization
of DCR fistula.
Success rates with silicon intubation
% of success
Study conducted
97.5%
Mirzaman etal
95%
Tarbat etal
98.14%
Talpur etal
95%
Advani etal
96%
Besharati MR etal
98%
Present study
Conclusion
• Meticulous surgery and proper identification
of structures.
• Big osteotomy esp, younger patients.
• Silicon tube intubation in all.
• Tight opposition of anterior flaps.