Conventional External Dacryocystorhinostomy Research Articles

Enhancing Precision: A Visual Guide to Drill-Assisted External Dacryocystorhinostomy Surgery.

This technical report aims to provide a visual guide to the drill-assisted external dacryocystorhinostomy (DCR) technique with silicone intubation. Through a step-by-step video demonstration, it addresses inherent documentation challenges and highlights crucial considerations. A critical aspect of the procedure's success lies in creating a clear space around the drilling area to prevent thermal burns and soft tissue wrapping around the burr. Additionally, it emphasizes the careful use of smaller burr diameters and the importance of drilling techniques, advocating for minimal perpendicular drilling while maintaining rotational polishing movements to minimize the risk of rapid penetration and potential nasal mucosal injury. The thermal cauterization of perforating nutrient vessels during bone drilling offers a significant advantage in reducing the risk of bleeding. A review of existing limited studies comparing drill-assisted and conventional external DCR reveals advantages such as shorter surgical duration, lower intraoperative hemorrhage rate, more regular osteotomy edges, increased ostomy patency, and potential prevention of soft tissue or mucosal injuries. Nonetheless, achieving these benefits necessitates enhanced hand and foot coordination. However, despite these benefits, a noticeable gap exists in the literature concerning comprehensive studies and comparative analyses. Furthermore, exploring the associated cost and learning curve of adopting this surgical technique is essential. This report aims to fill the existing gap in the literature and serve as a visual reference for surgeons interested in adopting drill-assisted external DCR.

Surgical Outcome of Endoscopic Dacryocystorhinostomy with and Without Prolene Stent in Chronic Dacryocystitis: A Randomized Controlled Trial.

Popularity of Endoscopic dacryocystorhinostomy is rising over a conventional external dacryocystorhinostomy. One of the most frequent reasons for procedure failure is the closing of neo-ostium. To compare the surgical results of endoscopic Dacryocystitis operations with and without Prolene stents in terms of procedure success rates and postoperative complications. A randomized controlled trial of 2years was carried out including 100 patients of chronic dacryocystitis. The cases were randomly split into two groups with 50 cases each in Endoscopic DCR with stent and without stent groups. The results, both the subjective and objective were noted. At the end of 3months, the overall success rate was 88% and 90% in group with and without stent respectively with no significant statistical difference. 12% subjects had wound infection, 8% had granulations around the rhinostoma, 6% had synechiae, 10% had discomfort from the tube in stent group. In Group B (without stent), 16% had wound infection, 4% had granulations around the rhinostoma. As Endoscopic DCR without stent has equally good results and less complications as compared to with stent, we recommend endoscopic DCR without stent. Use of Stent should be reserved for special conditions like revision cases, common canalicular block, fibrosed lacrimal sac.

Arrugas Bone Trephine Assisted Flapless Dacryocystorhinostomy with Circumosteal - Mitomycin C Versus External Dacryocystorhinostomy: A Hospital Based Comparative Study.

Primary acquired nasolacrimal duct obstruction is a common ophthalmic condition and has conventionally been managed by external dacryocystorhinostomy. However this procedure is time consuming and involves making mucosal flaps. The aim of this study was to compare the surgical outcome in Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C versus conventional external dacryocystorhinostomy. This is a retrospective non-randomized study of surgical outcome in patients of primary acquired nasolacrimal duct obstruction who underwent an Arrugas bone trephine assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C (group A) versus those who underwent conventional external dacryocystorhinostomy (group B) in a teaching hospital in North India. Patients with previously failed dacryocystorhinostomy, lacrimal fistula, canalicular and common canalicular obstruction were excluded. Success was defined as patent syringing at the end of one year. Surgical time was calculated from skin incision to skin suturing. There was complete resolution of epiphora with patent syringing in 43 out of 52 patients in group A, while in group B, 47 out of 55 patients had complete resolution of epiphora with patent syringing at the end of one year (p= 0.77). Mean surgical time was significantly lower in Group A than in Group B (p=<.05). Scarring and closure of the ostium was the most common cause of failure in both groups (Group A, n=5, 9.6%; Group B, n= 3, 5.45%). Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C is a viable alternative to conventional external dacryocystorhinostomy with comparable success rate and shorter surgical time and a faster learning curve.

Outcomes of Conventional External Dacryocystorhinostomy with and without Mitomycin C: Experience from Eastern Nepal.

Dacryocystorhinostomy (DCR) is the commonest surgery for nasolacrimal duct obstruction. Inhibition of the scarring process within the anastomosis and rhinostomy site which has been attributed to the failure of this procedure, might improve the success rate of DCR. The objective of this study was to evaluate the outcomes of DCR with Mitomycin-C (MMC) and to compare the results of DCR with and without MMC. A hospital based, prospective study was conducted in patients with primary acquired nasolacrimal duct obstruction. Standard conventional DCR was performed upto the level of creation of flaps. Application of MMC 0.2 mg/ml in and around the ostium and underneath the created flaps for two minutes was effected with cotton pledgets. The area was thoroughly washed with normal saline after removal of the pledgets. Rest of the surgery was completed as usual. The patients were followed up on the first postoperative day, one month and three months post surgery. A total of 60 cases, 30 in each group were allocated. The success rate of DCR with MMC was found to be 96.7% compared to 86.7% (p=0.35) in the DCR group at the end of three months duration. Intraoperative application of MMC during conventional DCR surgery provides a comparatively higher success rate than DCR without MMC without posing any extra financial burden and adverse drug reaction to the patient.

Outcome of Diode Laser Assisted Endoscopic DCR

Background and Objectives: Endoscopic laser dacryocystorhinostomy(DCR) is now a well established, effective approach to relieve nasolacrimal duct obstruction.The aim of DCR surgery is to create a permanent opening between the lacrimal sac &amp; nasal mucosa in patient of chronic dacryocistitis. There are many methods to perform DCR but our approach was diode laser assisted endoscopic DCR. The Objective is to study the outcomes of diode laser assisted endoscopic DCR.&#x0D; Material and Methods: This hospital based prospective non-randomized interventional clinical trial included 49 patients with chronic dacryocystitisat National Institute of ENTbetween august 2015 to July 2016. Success and complications were assessed by evaluating the patient at 1 week, 1 month, 3 month,6 month postoperatively and at least 3 month after removal of silicon tube those who were intubated by nasal endoscopy and sac patency test. Success was defined as absence of epiphora and patency of lacrimal drainage system.&#x0D; Results: Mean age with SD was 44.96 ±15.807 (Range 13 – 70 years). Patients between age group 40 – 60 yrs. was the highest (40.8%), Female were predominant 35 (71.4%) than male. Male Female Ratio was 1: 2.5. Septoplasty for DNS in 8 (16.33%) cases, turbinoplastyfor hypertrophied terbinatein 1 case were performed. Complications were injury to middle turbinate, sump syndrome, syneachia and granulation tissue formation. Overall success rate of DCR was seen in 87.76% cases.&#x0D; Conclusion: Laserassisted endoscopic DCR surgery eliminate the need of conventional external DCR. It is easy to perform, cosmetically good, high tech and has excellent outcome.&#x0D; Bangladesh J Otorhinolaryngol; April 2018; 24(1): 79-84

A Comparative study of conventional external dacryocystorhinostomy with dacryocystorhinostomy using intracystic implant

Dacryocystitis is a common manifestation in ophthalmology practice. external DCR is the definitive gold standard management. however many modifications in external DCR are proposed now a days, out of which dcr using intracystic implant is one. This study aiims at comparing the surgical outcome of external conventional DCR with that of DCR using intracystic implant. After a follow up period of 6 months it was observed that the success rate in connventional DCR is significantly better(97%) than DCR using intracystic implant(85%). However intraoperative blood loss and surgical time is significantly less in DCR using intracystic implant than the conventional external DCR. Keywords: Dacryocystorhinostomy, Intracystic Implant, Syringing, Nldo –Nasolacrimal Duct Obstruction.

Analysis of efficacy of intraoperative mitomycin C in external dacryocystorhinostomy

Analysis of efficacy of intraoperative mitomycin C in external dacryocystorhinostomy - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.081, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Outcome of External Dacryocysto-Rhinostomy (DCR) Operation Without Silicone Tube Intubation

Background: Dacryocysto-rhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac &amp; the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation.Methods: This study was conducted at Jahurul Islam Medical College Hospital, Kishoregonj, from July 2016 to January 2018. Fifty cases with chronic dacryocystitis were selected for the study. The operation was done under local anaesthesia. The patients were followed up for 3 months.Result: The mean age of the patient at the time of surgery was 40.9±13.1 years ranged from 16 to 65 years. Male to female ratio was 1:2.1. There were three patients with reactionary haemorrhage, one wound infection, two with wound gap, one epicanthal fold and one granuloma formation. There were no failed DCR in this series.Conclusion: Conventional DCR is the most common oculoplastic surgery performed for managing epiphora due to nasolacrimal duct obstruction.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 121-123

Transcanalicular laser-assisted dacryocystorhinostomy with diode laser

ABSTRACTThis article compares the efficacy of transcanalicular laser assisted dacryocystorhinostomy (TL DCR) with conventional external dacryocystorhinostomy (Ex DCR). All patients were randomly divided into two groups – Group A included patients who underwent TL DCR and Group B included patients who underwent Ex DCR. 168 operations were done in a total of 163 patients; 79 patients in group A and 84 patients in group B. The overall success rate was 90.12% in group A and 95.40% in group B. The mean total surgical time was 17.41 min in group A and 49.49 min in group B. The duration of stay in hospital was about 3 hours for group A and about 48 hours for group B. Intra and post operative complications were more in group B than in group A. TL DCR can offer a minimally invasive technique with comparable results and better patient satisfaction than Ex DCR.

A Study of Conventional Dacryocystorhinostomy Operation without Silicon Tube Intubation in a Secondary Hospital

Dacryocystorhinostomy (DCR) is a bypass surgery in which an anastomosis is made between the medial wall of the lacrimal sac &amp; the lateral wall of the nasal mucosa by cutting the intervening bone at the level of middle meatus to restore the flow of tears when the obstruction is beyond the common canaliculus. The only successful treatment of chronic dacryocystitis is DCR. The aim of this study was to evaluate the surgical intervention of conventional external DCR without silicon tube intubation. This prospective study was conducted at General Hospital, Faridpur from July 2012 to June 2014. Eighty cases with chronic dacryocystitis were selected for the study. We excluded the patients with lacrimal fistula, failed DCR and gross nasal pathology like deviated nasal septum, grossly hypertrophied inferior turbinate, atrophic rhinitis, nasal tumour, and polyp from our study. The patients' mean age at the time of surgery was 41.9±8.1 years ranged from 30 to 60 years. The operation was done under local anaesthesia by applying same technique. Then the patients were followed up for 12 months. In this study, we observed recurrence in five patients (6.25%) and complications from DCR are infrequent and not sight threatening. There were seven patients with reactionary haemorrhage, one wound infection, three wound gap, two epicanthal fold, one granuloma formation and five failed DCR. The success rate is 93.75% who underwent external DCR for the management of epiphora due to nasolacrimal duct obstruction.Faridpur Med. Coll. J. Jan 2015;10(1): 20-22

Aesthetic assessment in periciliary "v-incision" versus conventional external dacryocystorhinostomy in Asians.

To determine the functional and aesthetic outcomes of periciliary "v-incision" external dacryocystorhinostomy (DCR) and to compare with conventional approach. Charts review of consecutive cases of "v-incision" (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin-mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a "v" shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES). Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p < 0.01) than conventional DCR (observer #1 3.1 ± 2.8 and #2 2.8 ± 2.1, p < 0.01). More patients reported that they could wear spectacles within 1 week post-VDCR (44.7 vs 4.3 %, p < 0.01). "V-incision" external DCR has a similar functional success rate to that of the conventional approach and has superior aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were also influenced by the level of surgeon's expertise.

Modified external dacryocystorhinostomy with anterior flap anastomosis

Aims: To compare the surgical outcome of modified external dacryocystorhinostomy (DCR) with conventional external dacryocystorhinostomy and to evaluate the symptomatic relief of epiphora by Munk’s score. Materials and Methods: A prospective, interventional, comparative study of sixty patients with chronic dacryocystitis. They were divided into two groups; one group underwent conventional dacryocystorhinostomy whereas another underwent a modified technique of anterior flap anastomosis. Follow up period was eighteen months and were evaluated on the basis of sac syringing and Munk’s score. Statistical analysis was done by chi square test. Results: The mean age of the patients in our study in group 1 was 52.5 ±9.45 SD years (range 40-68 years) and group 2 was 51 ±10.15 SD years(range 38-70years) [Table 1].The female patients were more in both groups. The mean surgical time in group1 was 60.47 min ±5.14SD minutes, and group 2 was 84.66 ±3.99SD minutes.Surgical success was defined on the basis of patency of sac on syringing and improvement in Munk’s score at the end of eighteen months. Conclusion: The modified technique is easier to perform and equally effective alternative method for dacryocystorhinostomy. Key words: Anterior flap anastomosis, Conventional DCR, Modified external DCR, Munk’s score.

Novel Technique to Appose Flaps Using the BioGlue in the External Dacryocystorhinostomy

To introduce the sutureless technique to appose flaps using the BioGlue composed of bovine serum albumin (45%) and glutaraldehyde (10%) in the external dacryocystorhinostomy (DCR). The clinical chart was reviewed, retrospectively. The authors studied 31 case series of 30 patients who underwent the external DCR using the BioGlue in the step of apposing flaps. Instead of the suture technique, BioGlue was applied to appose flaps. Other steps were performed in the similar fashion to the conventional external DCR. And also, authors studied 31 case series of 30 patients who underwent the external DCR with conventional suture technique. Mean follow-up period is 12.5 months in study group and 12.6 months in control group. During mean follow up, 3 cases of membrane formation were observed, and patency of the anastomosis was kept well established in 28 cases (90%) in both groups. Sutureless apposition of flaps using the BioGlue can be an alternative method for the conventional suture technique in the external DCR. Also, it is easy and safe procedure to perform.

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

Background:Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.Aim:To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications.Study Design:Prospective non-randomized comparative study.Materials and Methods:Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ2 test.Results:Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609).Conclusion:Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

Endonasal dacryocystorhinostomy with mucosal flaps: our experience.

The endoscopic dacryocystorhinostomy (DCR) has distinct advantage over external DCR. There is no ugly scar on the face, less intraoperative bleeding, it is a daycare procedure and patient is discharged on the same day evening. Endoscopic DCR is considered to be a superior alternative technique to the conventional external DCR. Patients diagnosed with nasolacrimal duct obstruction between Jan 2009 and Jan 2011 were included in the study. One hundred and twenty endo DCR were performed with conventional 'cold steel' instruments. The technique involved complete exposure and marsupialization of the lacrimal sac. The surgical technique involved the creation of nasal mucosal and large posterior lacrimal flaps at the medial lacrimal sac wall and the two flaps were placed in close apposition. Success was defined as complete resolution of epiphora and a patent lacrimal system, evaluated by lacrimal irrigation and endoscopy, 1year postoperatively.

An unusual variation in the anatomy of the uncinate process in external dacryocystorhinostomy

Variations in the bony components of the nose are often encountered. One such variation was found in a 49-year-old male who had undergone conventional external dacryocystorhinostomy for adult onset nasolacrimal duct blockage. Intraoperatively, a thick bar of bone was seen beneath and parallel to the lacrimal sac fossa after a complete osteotomy had been made. Another osteotomy had to be fashioned in this bone to reach the nasal cavity. Postoperative 3D computed tomographic scan revealed the bone to be an anatomical variation of the uncinate process of the ethmoidal bone which was rather anteriorly placed, much thicker than usual, and attached to the nasal roof. The uncinate process is thin, curved and its anterior edge may frequently overlap some part of the lacrimal fossa. However, to our knowledge, the presence of such a large and thick uncinate process necessitating an additional large osteotomy has not been reported.

Transient recurrence of pressure regurgitation following successful conventional external dacryocystorhinostomy

To report a patient with transient recurrence of lacrimal pressure regurgitation following a successful conventional external dacryocystorhinostomy. A 22-year-old female, who had undergone conventional external dacryocystorhinostomy, presented 3 days later with a recurrence of pressure regurgitation. The patient's symptoms disappeared spontaneously 7 days later. Serial naso-endoscopic examination was used to find the cause. Endoscopic examination showed an oedematous posterior nasal mucosal remnant obstructing the lacrimal drainage pathway. On account of its peculiar location, shape and movements, and the surgically induced tissue oedema, this mucosal remnant misdirected the fluid coming through the canalicular system away from the nasal cavity into the lacrimal pocket. Ten days later, due to healing fibrosis, this flap adhered permanently to the lateral nasal wall and the patient's symptoms disappeared spontaneously. Nasal endoscopy is a simple, quick and convenient technique for diagnosing the cause of obstruction in the lacrimal drainage system. The surgeon should aim for large anterior lacrimal and anterior nasal mucosal flaps, and every remnant of posterior flaps should be excised during dacryocystorhinostomy.

Mechanical Endonasal Dacryocystorhinostomy Versus External Dacryocystorhinostomy

To compare the success rates of a new mechanical endonasal dacryocystorhinostomy (MENDCR) technique and the conventional external dacryocystorhinostomy technique (Ext-DCR). A prospective, nonrandomized interventional comparative case series of 31 consecutive MENDCRs and 24 Ext-DCRs performed from January 1999 to December 2000. Patients with anatomic nasolacrimal duct obstruction were included in the study; previous lacrimal surgery and functional nasolacrimal and canalicular obstruction were exclusion criteria. Two surgeons performed the MENDCRs, using a standardized operative technique, which involved creation of a large bony ostium and mucosal flaps between the lacrimal sac mucosa and nasal mucosa. One surgeon performed all Ext-DCRs. Twenty-seven patients (8 men, 19 women) underwent 31 MENDCRs. The average age of the patients was 62.9 years (range, 15 to 86 years; SD, 19.1 years). In 11 cases (35.4%), a septoplasty was required at the time of surgery, and in 6 cases (19%), further endoscopic sinus surgery was performed. In the Ext-DCR group, 23 patients (7 men, 16 women) underwent 24 DCRs. The average age was 59.6 years (range, 22 to 86 years; SD, 18.5 years). No other nasal procedures were performed at the time of surgery in this group. The average follow-up time was 13 months for the MENDCR group and 12.4 months for the Ext-DCR group. Success was defined as relief of symptoms and by anatomic patency, which was assessed by history, fluorescein flow on nasal endoscopy, and lacrimal syringing. In the MENDCR group, surgery was successful in 29 of 31 DCRs (93.5%); 1 of 2 failed cases was anatomically patent but symptomatic, yielding an anatomic patency rate of 96.8%. In the Ext-DCR group, the success rate was 95.8% (23/24 DCRs); the failed case was anatomically patent but symptomatic, giving an anatomic patency rate of 100%. The differences in overall success and anatomic patency were not statistically significant (P = 0.6 and P = 0.56, 1-tailed Fisher exact test). The success rate of MENDCR (93.5%) compares favorably with that of standard external DCR (95.8% in this study). MENDCR relies on the creation of a large ostium and mucosal flap apposition. A larger, randomized prospective trial is needed to fully assess the efficacy of this new technique.

Endonasal laser dacryocystorhinostomy in outpatient clinic

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.

Experience with bicanalicular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinostomy

Aim: The aim of this study was to assess the success rate of bicanalicular intubation of lacrimal drainage apparatus in chronic dacryocystitis patients who were at high risk of failure of surgery of dacryocystorhinostomy. Material and methods: A total of 24 patients with chronic dacryocystitis (25 eyes) including 11 males and 13 females (age range 3–80 years) having high risk factors of failure of dacryocystorhinostomy were enrolled. Factors such as previous attacks of acute dacryocystitis, trauma in lacrimal sac region, previously failed dacryocystorhinostomies, formation of false passages in the lacrimal drainage apparatus were considered. Conventional dacryocystorhinostomy followed by bicanalicular intubation of the lacrimal drainage apparatus with Jain metal silicone the lacrimal intubation tube (20–23 gauge) was performed in all these patients. The patients were followed up at weekly intervals for two months, at 6 months and at 1 year post surgery. Results: A total of 25 eyes in 24 patients (including 11 males and 3 females) were operated upon using the technique of bicanalicular intubation of lacrimal drainage apparatus with conventional external dacryocystorhinostomy. The procedure was successfully performed in 22 out of the 25 eyes. Perioperative complications included punctual damage due to recurrent attempts at passing these probes in 2 patients and mild damage to nasal mucosa in 5 patients. The majority of patients did not experience any untoward symptoms from these silicone tubes. However, in three eyes there was felt a mild foreign body sensation and two patients had chronic conjunctival erythema. The tubes could not be retained in two of these three eyes. Additionally, in one eye there was spontaneous extrusion of tubes whilst sneezing 3 months after surgery. All these three eyes had a recurrence of symptoms due to non-retention of the tubes and needed re-operation. On average the tubes were retained for a period of six months before they were spontaneously extruded or removed. Fifteen patients retained the silicone tubes for more than 1 year. The procedure gave a success rate of 76% (19/25 eyes) and these were the eyes in which the tubes had been retained for more than 6 months. The success was not influenced by the age or sex of patient, laterality of eye, aetiology of chronic dacryocystitis, or evidence of bony deformity or abnormality of the sac. Conclusions: Bicanalicular intubation for lacrimal drainage system is a simple, inexpensive and straight forward adjunct to conventional external dacryocystorhinostomy. The procedure is strongly indicated for patients with chronic dacryocystitis who are at high risk of surgical failure. Carefully performed, it gives a 76% success rate and is not influenced by the different variables examined.