External Dacryocystorhinostomy with Silicone stent in Anatomical and Functional primary acquired nasolacrimal duct obstruction

Vasu Narasimha Naik,Kumar V

doi:10.18231/j.ijooo.2020.026

Abstract

To compare the benefits and complications of External dacryocysto rhinostomy (EXDCR) with Silicone tube (ST) intubation in anatomical primary acquired naso lacrimal duct obstruction (APANDO)and functional primary acquired naso lacrimal duct obstruction(FPANDO) patients.Patients with epiphora/discharge/mucocele are grouped into group A (APANDO) and group B (FPANDO) based on diagnostic probe test, positive syringing and Fluorescein Dye Disapearance (FDD) test. Both group underwent EXDCR with ST intubation. Patients were evaluated for subjective and objective resolution of epiphora/discharge/mucocoele, complications and subjective satisfaction at the end of 6 months.There were 23 patients each in group A and group B and no difference in demographic and laterality of eye involvement. Epiphora was common presentation in FPANDO (91%) and discharge in APANDO (57%). (P =0.01). The success rate is 78.3% (18/23) in group A and 86.9% (20/23) in group B and the difference is not significant (P=0.69). Tube related complications are high in group B 82.6% ( = 0.01) and inflammation related complications in group A 61.2% (P=0.49). In group A 82.6% (19/23) and group B 73.9% (17/23) were satisfied with the procedure (P =0.72). Tube related complication and additional financial burden are the main factors for dissatisfaction in group B (= 0.72)Use of silicone tube does not alter the success rate of EXDCR in APANDO and FPANDO. Preoperative counseling and eye health educations are very important before doing such procedure on rural population.

Highlights

Epiphora is the commonest presenting symptom in Primary acquired naso lacrimal duct obstruction (PANDO)
Most commonly accepted explanation for anatomical PANDO (APANDO) is downward and upward inflammation of the lacrimal duct leading to fibrosis of the duct wall
Altered lacrimal pump action, reduced capillary function of the lacrimal puncta and canaliculi are the reason for functional PANDO (FPANDO). 1,2

Summary

Introduction

Epiphora is the commonest presenting symptom in Primary acquired naso lacrimal duct obstruction (PANDO). Both anatomical and functional blocks are attributed for epiphora. Altered lacrimal pump action, reduced capillary function of the lacrimal puncta and canaliculi are the reason for functional PANDO (FPANDO). The gold standard treatment for PANDO is External dacryocystorhinostomy (EXDCR) with success rate of 59%. 2,5,7–10 Functionally altered lacrimal pump system in the form of functional loss of sac vacuum portion of lacrimal tear pump,reduced canalicular pumpa action, sac reduced venture effect at the nasal opening due to reduced rhinostomy movement. Many modifications have been attempted to improve the success rate of EXDCR.

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Discussion

Conclusion