Endonasal laser dacryocystorhinostomy in outpatient clinic

Abstract

The endonasal laser dacryocystorhinostomy (DCR) was performed in five patients with obstruction after conventional external DCR. The surgery was performed in an outpatient setting with local anesthesia. After intranasal superficial anesthesia with gauze impregnated with 4% lidocaine hydrochloride diluted with 5000-fold epinephrine, 0.5% lidocaine hydrochloride was injected. A 20-gauge light probe, originally developed for vitrectomy, was inserted from the upper punctum. The obstructed region was illuminated using the light probe and was observed intranasally with the endoscope. The KTP laser was delivered through a 0.4-mm quartz fiber that was passed through the hand-piece for nasal surgery. The mucosa surrounding proposed rhinostomy was vaporized by the laser (continuous wave, 5 to 8 W, near-contact mode). The obstructed region was then opened and the desired rhinostomy size was achieved. Bicanalicular silicone tube intubation of the surgical ostium was performed. No complications occurred during and after surgery. The ostium continued to be patent, and the patients were free of symptoms. We concluded that the endonasal laser DCR is useful for reconstruction after conventional DCR.