Corrective techniques of lacrimal obstruction in the vertical system

Abstract

PurposeTo describe current surgical techniques of dacryocystorhinostomy (DCR) and compare their effectiveness by analyzing the advantages and disadvantages between external, endonasal and transcanalicular surgery. Patients and methodsA total of 91 DCRs were analyzed using a retrospective, cross-sectional and multicentre study in 75 patients who had symptoms of nasolacrimal duct obstruction. Of these, 28 were operated using external DCR, 31 endonasal technic, and 32 transcanalicular DCR with diode laser. Outcomes were evaluated subjectively using patient symptoms for the grade of epiphora and the results from the syringing before and after surgery. ResultsExternal DCR was performed in 28 cases, with 19 cases asymptomatic (67.85%), and 20 patients had a patent tract (71.42%). Endonasal DCR was performed in 31 cases, of which 19 cases were asymptomatic (61.29%), and 21 showed patency of the nasolacrimal duct (67.74%). A transcanalicular technique was performed in 32 cases, with absence of epiphora in 24 patients (75%), and the syringing was successful in 24 of them (75%). ConclusionsAny of these 3 surgery techniques would be an adequate treatment for lacrimal obstruction, due to the significant development of endonasal and transcanalicular techniques in recent decades. With improvement, we could use either endonasal or trans-canalicular techniques with diode laser with the same level of effectiveness as the classic external approach, with the advantages of minimally invasive surgery.