External Dacryocystorhinostomy Surgery Research Articles

Outcome of External Dacryocystorhinostomy Operation with and without Posterior Nasal Mucosal Flap Suturing Technique in Combined Military Hospitals of Bangladesh

Introduction: External Dacryocystorhinostomy is an anastomosing operation which creates a fistula between the medial wall of lacrimal sac and lateral wall of nasal cavity. Objectives: To compare the success rate by suturing both the anterior and posterior nasal mucosal flaps and without suturing the posterior nasal mucosal flap in External DCR surgery of 50 cases in different Combined Military Hospitals (CMH) of Bangladesh. Methods: The study included 50 cases of Chronic Dacryocystitis patients with symptoms of epiphora and blocked Sac Patency Test (SPT). External Dacryocysto- rhinostomy (DCR) surgery was done by same surgeon in different CMH over the period of 02 years extending from January 2016 to December 2017. Total 50 patients were divided into equal 02 groups. Group A underwent External DCR with silicone tube intubation and both anterior and posterior nasal mucosal flaps were sutured. Group B underwent similar DCR surgery where only anterior nasal mucosal flaps were sutured with lacrimal sac flap and posterior mucosal flap was excised completely. Results: External DCR surgery success rate was evaluated by a patent SPT at 03 months, 06 months and 12 months post operatively in both groups. SPT was successful in 92% cases in group A and 96% in group B at 3 months follow up after silicone tube removal. At 6 months reduction of epiphora occurred in 90% cases in Group A and 96% cases in Group B with unchanged SPT percentage. At 12 months follow up result remained unchanged as found at 6 months. There was significant difference in success rate of two different surgical technique. Quality of surgery improved with less intraoperative complications with shorter surgical time when only anterior nasal mucosal flap was sutured with excision of posterior nasal flap. Conclusion: This study suggested that comparing both the techniques of with and without suturing anterior and posterior nasal mucosal flaps in external DCR surgery, the later one makes considerable improvement in success rate of DCR. Excising the posterior nasal mucosal flaps can reduce operation time, improve operation technique and reduced epiphora post surgically. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 31-33

Evaluation of the relationship between tear meniscus changes and quality of life outcomes after external dacryocystorhinostomy.

This study aims to investigate the effects of external dacryocystorhinostomy (DCR) surgery on tear meniscus parameters and assess its relationship with improvements in quality of life (QoL) in patients with nasolacrimal duct obstruction (NLDO). This prospective study included 30 patients diagnosed with NLDO who underwent external DCR surgery. Tear meniscus (TM) parameters, including height, depth and area, were measured using anterior segment optical coherence tomography. Lacrimal symptom questionnaire (LacQ), Munk scores and Glasgow benefit inventories (GBI) were collected. Statistical analysis was performed to evaluate the correlation between tear meniscus changes and improvements in QoL. TM height, depth and area decreased from preoperative median measurements (0.09mm2, 0.37mm, 0.56mm) to postoperative median measurements (0.03mm2, 0.21mm, 0.30mm) (p < 0.001). Lacrimal symptom scores and Munk scores showed a significant improvement at 3-month postoperatively (p < 0.001). The GBI scores also demonstrated a significant improvement, indicating a positive impact on the patients' QoL. (p < 0.001). A statistically significant correlation was found between the change in TM parameters and LacQ lacrimal symptom scores. External DCR surgery leads to significant improvements in tear meniscus parameters and quality of life outcomes in patients with NLDO. The decreased in TM height and TM area indicates improved tear film dynamics and decreased tear volume, which positively impact the patients' ocular comfort and overall well-being. This study highlights the importance of tear meniscus evaluation as a potential market for assessing the success of DCR surgery and its impact on patients' QoL.

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.

Comparison of success between external and endonasal dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction in South India population

Background: Dacryocystorhinostomy (DCR) has been the standard procedure for primary acquired nasolacrimal duct obstruction (PANDO) for many years. This process can be performed either using an endoscopic or external approach. Aims and Objectives: The aim is to evaluate the results and recurrence rates of external DCR (ExDCR) and endonasal DCR (EDCR) surgery in patients with PANDO in the South Indian population. Materials and Methods: Medical records were reviewed in all patients who underwent surgery for PANDO between December 2021 and August 2023 at Government Medical College Mahabubabad. Results: This study was conducted in 92 patients; 34 males (36.96%) and 58 females (63.04%) were the gender split. ExDCR was used in 52 (56.52%) of the cases, and EDCR was used in 40 (43.487%) of the cases. Operation success rates of these data revealed that 50 (54.34%) cases were recorded as successful, 24 (26.10%) of the cases were accepted as partially successful, and 18 (19.56%) of the cases were deemed unsuccessful. There was no statistically significant difference between success rates and recurrences in both groups (P&gt;0.05). Conclusion: Endoscopic DCR produced simple, minimally invasive, and preferable results compared to ExDCR in the South Indian population. Although the success of ExDCR is higher and the recurrence is lower than endoscopic DCR, with the outcomes of this study, endoscopic DCR can be tried as the first choice to protect the patient from major surgery and anesthesia in PANDO.

Comparison of the Results of Anterior and AnteriorPosterior Flap in External Dacryocystorhinostomy Surgery

Comparison of the Results of Anterior and AnteriorPosterior Flap in External Dacryocystorhinostomy Surgery

Intradermal suture post-surgical scar in external dacryocystorhinostomy: technique and patient satisfaction survey

Purpose: Dacryocystorhinostomy surgery may result in significant postoperative scarring. Although other surgical techniques have been developed that achieve a better aesthetic result, the ab externo technique remains the gold standard for this procedure. We developed a telephone survey to evaluate the visual impact of postoperative skin scars associated with ab externo dacryocystorhinostomy. Methods: 470 patients underwent uncomplicated external dacryocystorhinostomy surgery by two consultant surgeons from January 2014 to December 2021. Skin incisions were closed using intradermic continuous suture with prolene 6.0. The exclusion criteria were cases of dacryo-phlegmon and lacrimal sac fistulae with skin maceration. The visual effect of the postoperative scar was evaluated, and the degree of patient satisfaction was measured by a questionnaire with four subjective perceptions of the scar (very good, good, bad, very bad) given by a physician in the first postoperative month. The survey responses were used as the basis for a literature review. Results: The survey received 470 responses (100%) Very good perception of the scar was achieved in 75,8% of patients. There were no other post-operative complications noted from medical records review. Conclusions: Given the small percentage of patients who complained of marked scarring, it should not be the main reason for deciding on the procedure for dacryocystorhinostomy, especially in elderly patients. Therefore, the surgical technique should be considered as a surgically acceptable choice if cosmetic results were selection criteria in the case of total stenosis of the nasolacrimal duct.

Role of Oral Tranexamic Acid in Reducing Peroperative and Postoperative Hemorrhage in External Dcr Surgery

Background: External dacryocystorhinostomy (DCR) is now a well-established, effective approach to relieve nasolacrimal duct obstruction. Per operative hemorrhage obscure the operative field during surgery.so it is difficult to carry on an uncomplicated surgery. Moreover postoperative hemorrhage has become an added problem. The objective of this study is, to evaluate the effect of oral tranexamic acid in reducing both per operative and postoperative hemorrhage in external DCR surgery. Methods: This hospital based interventional quasi experiment included 60 patients with chronic dacryocystitis at DMCH between January 2014 to June 2014.Oral formulation of tranexamic acid 500mg two capsule and tablet Vit B complex as placebo started 1 hour prior to DCR surgery and continued up to second postoperative day in intervention and control group respectively. In every case, the rate of hemorrhage was evaluated peroperatively and postoperatively. Findings: In this study, mean duration of operation was 35.98 (range 30 to 51) min in group-A and 54.13(45-75min) minutes in group-B. Perioperative mean blood loss was of 15.03 ml with a maximum blood loss of 25ml in group A and was 33.57ml with maximum blood loss of 39ml in group B. Mean postoperative bleeding was 2.55ml with maximum blood loss 5ml In group A and was 5.53ml with maximum blood loss 13ml in group B. postoperatively no bleeding was found in 24(73.33%) cases in group A and 10(40%) cases in group B. Conclusion: This study suggests that oral tranaxemic acid significantly reduces peroperative and postoperative hemorrhage and reduces duration of surgery and improves the quality of DCR surgery. J Dhaka Med Coll. 2021; 30(2) : 196-201

Eyelid Blink Lagophthalmos and Blinking Velocity Changes After External Transcutaneous Dacrocystorhinostomy: A Prospective Study

To investigate the changes in eyelid blinking dynamics after external dacryocystorhinostomy (DCR). Prospective before-and-after study with follow-up. Patients undergoing external DCR surgery for primary acquired nasolacrimal duct obstruction were observed using high-speed videography that recorded eyelid blinking of both eyes for a total duration of 4 minutes at a rate of 120 frames per second. These recordings were taken before the surgical procedure, on postoperative day 3, and then at 1 week, 1 month, and 3 months after the DCR surgery. A total of 3 random blinks were selected and isolated from each video recording for data analysis. For each blink, lagophthalmos and eyelid blinking velocity were calculated for the operated eye, and their values were then compared with those calculated for the contralateral, nonoperated eye. Data were obtained for 22 patients. Operated eyes showed large postoperative lagophthalmos on postoperative day 3, with a mean of 56.58% ± 52.63% of the palpebral fissure height. Gradual improvement of the lagophthalmos occurred over the next follow-up visits, and reached a mean of 31.24% ± 36.71% at follow-up visit 3 months postoperatively. The velocity of eyelid blinking showed a significant reduction for the operated eyes, with gradual improvement over 3 months. Postexternal DCR eyelid blinking changes included significant blink lagophthalmos with decreased velocity of eyelid blinking which gradually improved over the 3-month follow-up period. A longer follow-up period may be required to confirm if eyelid blinking lagophthalmos and velocity will return to baseline levels.

External Dacryocystorhinostomy Surgery at Biratnagar Eye Hospital, Nepal

Introduction: Nasolacrimal duct obstruction at the junction of the lacrimal sac and nasolacrimal duct causes acute or chronic dacryocystitis. Dacryocystorhinostomy (DCR) is the treatment of choice and has a high success rate. Objective: To analyze the success rate of external DCR surgery and its influencing factors at our hospital. Methods: It is a hospital-based descriptive study of cases that underwent external DCR surgery from June 2016 to February 2017 at Biratnagar eye hospital. The demographic data were recorded and the successful outcome of the surgery along with its influencing factors -tube status, operating surgeons, and gender was analyzed. The main outcome measure was defined as a patent lacrimal passage on syringing at 6 months postoperatively. Chi-square and Fisher’s exact test were used for statistical analysis. Results: In total 317 patients, the mean age of the patients was 38.46 (SD ± 13.6) years. The male to female ratio was 1:2.5. The commonest presenting symptom was watering with discharge in 224 (70.6%) patients. Of the total, 195(61.5%) had undergone the DCR surgery with intubation and 122 (38.5%) without intubation. Only 114 (35.9%) patients were followed up for 6 months. The success rate was 86.8%. Postoperative wound infection, bleeding or cheese wiring of the punctum was not seen. No statistically significant factors were seen to influence the success rate of DCR surgery. Conclusions: External DCR surgery has a high success rate and no significant influencing factors were found to define its success in this study.

Changes in Tears Monocyte Chemoattractant Protein-1 Level After External Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction.

The authors aimed to define tears monocyte chemoattractant protein-1 (MCP-1) changes after external dacryocystorhinostomy surgery. Tears samples were collected with a Schirmer strip and stored in Eppendorf tubes at -80°C. At the end of the study, the papers were cut into small pieces and incubated with phosphate-buffered saline solution. Monocyte chemoattractant protein-1 levels were determined by using an enzyme-linked immunosorbent assays kit. The MCP-1 levels were 498.66±101.35, 576.40±149.78, 422.53±85.94, and 436.96±81.38ng/L before surgery, in the first week, the first, and third months after surgery, respectively. Its level significantly increased in the first week compared with the preoperative level ( P <0.001). There was a prominent decrease in the postoperative first month ( P <0.001). In the third postoperative month, the mean MCP-1 level was not significantly increased compared with the postoperative first month ( P =0.196). The tears MCP-1 level was significantly decreased after external dacryocystorhinostomy surgery.

Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery in Mongolians.

To study the affect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies (DCR) performed by the traditional external (EX-DCR) approach or an endoscopic (EN-DCR) endonasal approach. A total of 292 consecutive cases with primary nasolacrimal obstruction underwent DCR surgery. Orbital computed tomography scan was used to measure lacrimal sac fossa and other related structures and Lac-Q questionnaire was used to compare surgery result. Maxillary portion of lacrimal sac fossa is thicker in failed surgery group than successful surgery group (P<0.05). Lateral nasal structures (uncinate process, operculum of the middle turbinate, agger nasi) are dominantly adjusting to lacrimal sac fossa in failed surgery group (P<0.05). Patients who underwent EX-DCR has a 6.0-point and EN-DCR group 11.0-point improvement (P<0.016) in Lac-Q questionnaire. Patients who have a thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, ethmoid cells adjusting to lacrimal fossa are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR and the EX-DCR approach have an equivalent surgical success rate but improvement in quality of life by using the Lac-Q questionnaire is greater in the endoscopic group when compared with the external.

Surgical Outcomes of External Dacryocystorhinostomy Under Local Anaesthesia in a Tertiary Care Hospital: A Prospective Cohort Study

Objective: This study was designed to conclude the success rate of external dacryocystorhinostomy surgery, patient concerns about surgical scar mark and their satisfaction with the appearance of surgical scar. Methods: A prospective cohort study was conducted at Department of Ophthalmology, Gujranwala Medical College/ Teaching Hospital. Total 74 operated cases of DCR surgery under local anaesthesia in two year period (2018-19) were included. Mean follow-up was up to 11 months. Surgical success was defined as resolution of complaint of epiphora. Surgical failure was defined as blockage of lacrimal pathway on syringing. Patient concerns about surgical scar mark and their satisfaction with the appearance of surgical scar was also assessed by telephonic interview. Results: Out of 74 patients 61 (82.43%) were female and 13 (17.56%) were male. Mean age of patients was 39.49 ± 14.26 years.10 patients had epiphora at the end of follow-up. Majority of failed cases presented at 3 month. Lacrimal syringing on 1 week follow-up was effective to clear any debris or blood clot. The success rate (86.49%) calculated from those patients (n = 67) who completed the follow-up. 46 (68.65%) were not satisfied with the appearance of their surgical scar mark. Conclusion: External DCR performed in local anesthesia is a safe procedure with a success rate of above 85% at one year follow-up. Lacrimal pathway syringing, on follow-up after DCR surgery, can be effective to wash blood clot or debris. Majority of the patient do not find surgical scar mark cosmetically acceptable.

External Dacryocystorhinostomy and Patient Satisfaction: Perspective of General Ophthalmologist.

This study aimed to evaluate patient satisfaction over time in patients undergoing external dacryocystorhinostomy for primary nasolacrimal duct obstruction when done by a general ophthalmologist. This prospective interventional case series was done in a secondary level eye hospital in the Midwestern region of Nepal from 1st January 2018 to 30th December 2018. Fifty-four consecutive adult patients diagnosed with primary nasolacrimal duct obstruction who underwent external dacryocystorhinostomy performed by a general ophthalmologist were included. The surgical success rate was determined at six months on the basis of the resolution of symptoms with patency on syringing. Postoperative patient satisfaction was evaluated 6 months after surgery with a standardized Glasgow Benefit Inventory and post-intervention questionnaire. A total of 54 eyes were operated on within the study period and a larger number of surgeries were done in the age group 26-30 years. Female constituted 79.6 % and male 20.4% with a ratio of 3.9:1. Overall surgical success rate 6 months after surgery was 96.30%. The mean total Glasgow benefit inventory (GBI) score was 48.83 ± 23.87 (95% CI, 42.96- 56.95), mean general subscale score was 52.70± 23.28 (95% CI, 46.49-60.38), social support subscale was 49.69 ± 44.68 (95% CI, 41.15-60.35) and physical health subscale score was 37.07 ± 41.19 (95% CI, 27.48-49.26). The external dacryocystorhinostomy surgeries performed by general ophthalmologists achieved an excellent surgical success rate and good patient satisfaction proven by a validated questionnaire.

The Ophthalmology Surgical Competency Assessment Rubric for External Dacryocystorhinostomy Surgery.

The International Council of Ophthalmology (ICO) is currently developing a series of standardized, internationally validated, teaching tool for key ophthalmic surgical procedures called the Ophthalmology Surgical Competency Assessment Rubrics (OSCARs). This study aims to develop an OSCAR for external dacryocystorhinostomy (ExDCR). An international panel of content experts, representing Argentina, India, U.A.E., United Kingdom, and the U.S.A. was established and worked to develop the rubric using a range of online collaboration tools. The team used the standardized OSCAR template as a baseline, developing explicit behavioral descriptors (the behavior and performance expected for each step) that were reviewed and modified with successive models. Learners were scored on a modified 4-point Dreyfus scale of skill acquisition (novice, beginner, advanced beginner, competent) with the removal of the expert domain. The tool was then reviewed by a secondary panel of international content experts, representing Brazil, India, Iran, Singapore, United Kingdom, and the U.S.A. The final OSCAR ExDCR tool was developed in alignment with the ICO-OSCAR standard. Nineteen agreed and weighted stems were produced. Specific comments with regards to the parameters and wording were incorporated to formulate the final rubric, which was internationally agreed and demonstrated face and content validity. The OSCAR ExDCR is skill and behavior based, has ICO agreed standards for assessment, and provides learners with specific targets for improvement. Although the OSCAR tool has face and content validity, further development could better elucidate its precise role.

Clinical -to- Pathological Correlation of Lacrimal Sac Specimens Obtained During Dacryocystorhinostomy Surgery

Purpose: To correlate the clinical data to the histopathological characteristics of lacrimal sac and bone specimens in adult patients undergoing indicated external transcutaneous dacryocystorhinostomy surgery (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) in order to determine the important clinical parameters that may necessitate selective lacrimal biopsy in certain situations.Methods: This is non-comparative, non-controlled descriptive case series study with histopathological correlation. Lacrimal sac and bone specimens for each case were collected during DCR from consecutive patients with PANDO presenting to the outpatient clinic of “Ain Shams University” hospitals, then sent for histopathological examination.Results: Fifty-one lacrimal specimens were obtained from a total of 49 consecutive patients who underwent external DCR for clinical PANDO at the time interval from March 2018 to March 2020 at “Department of Ophthalmology, Ain Shams University” operating theatre. The mean patients' age was 44.82± 13.63 years (range 21- 75). Among the 49 patients recruited, 6 (12.2%) were males and 43 (87.8%) were females. Non -specific lacrimal sac pathology was present in all 51 samples (3.9% acute inflammation and 96.1% chronic non-specific inflammation). Of the chronic non-specific inflammation specimens, mild degree of inflammation was seen in 40.8%, 44.9% showed moderate chronic inflammation, whereas only 14.3% showed severe inflammatory changes. The only two clinical parameters that were strongly correlated with the severity of inflammation are the intraoperative appearance of the sac and the presence of a lacrimal fistula with P-value (

The success rate of external dacryocystorhinostomy with and without suturing the posterior mucosal flaps

Background: The aim of this prospective study was to compare the success rate of external dacryocystorhinostomy (DCR) with and without suturing the posterior mucosal flaps. Material and methods: One hundred patients who underwent external DCR surgery were included in this study. They were divided into group A and group B, with 50 patients in each group. In group A, patients who underwent an external DCR with only anterior flaps sutured and removal of posterior flaps were included. In group B, patients who underwent an external DCR with both anterior and posterior flaps sutured were included. All patients came for a follow-up visit at one week, one month, three months, and at six months. The success rate was evaluated by symptomatic relief from epiphora and patency on syringing performed at the follow-up six months after DCR. To evaluate differences in both groups, a Chi-square test was used. A p-value less than 0.05 was considered statistically significant. Results: The success rate was 98% in group A, and 84% in group B. Our results show the success rate was higher in group A where anterior flaps were sutured, and posterior flaps were excised. The difference was statistically significant (p-value < 0.05) Conclusions: This study shows that DCR surgery with anterior flaps anastomosis and excision of posterior flaps has a higher success rate than anterior and posterior flaps anastomosis.

Outcomes of External Dacryocystorhinostomy under General and Local Anesthetics in a Tertiary Clinic.

Objectives:In our clinic, although we prefer to perform dacryocystorhinostomy (DCR) under general anesthetics, we also perform it under local anesthetics for patients with a high risk of general anesthesia. Herein this study, we aimed to present our experiences in external DCR under both general and local anesthetics in a tertiary clinic.Methods:Medical records of the patients who had epiphora, were followed up in the oculoplastic section between January 2014 and December 2020 were collected. Patients who underwent external DCR were included in the study. Patients were divided into two groups: local and general anesthesia. All demographic characteristics of patients, previous DCR, history of dacryocystitis, surgery time, perioperative complications, and the American Society of Anaesthesiology (ASA) physical status score were recorded.Results:A total of 106 eyes from 82 patients were included in the study. The mean age of the patients was 57±24 years (range 18–89) and the median age was 56. Of 82 patients, 49 were female and 33 were male. 24 patients underwent bilateral external DCR. The mean surgery time for the general group and the local group was 66±12 min and 52±7 min, respectively. A significant difference was observed between the general and local groups in terms of the duration of the surgery (p=0.03). Of these, 11 patients underwent revision DCR during the follow-ups, and 7 patients were in the general group and 3 patients were in the local group. The overall success rate was 90%.Conclusion:External DCR surgery with both general and local anesthesia is a very effective technique for the treatment of nasolacrimal duct obstruction. In addition, local anesthesia may be brought to mind as an option considering less bleeding, shorter discharge time, and cost-effectivity and also to avoid perioperative and postoperative systemic complications for patients with high risks of general anesthesia.

Endoscopic dacryocystorhinostomy versus external dacryocystorhinostomy for treatment of primary acquired nasolacrimal duct obstruction

Background Dacryocystorhinostomy (DCR) is an operation that creates a lacrimal drainage pathway into the nasal cavity to facilitate drainage of the previously obstructed excreting system.Objective To compare effectiveness and complications of external and endoscopic DCR for treatment of primary acquired [nasolacrimal duct obstruction (NLDO)].Patients and methods The present study included 60 patients (38 females and 22 males) aged between 18 and 50 years complaining of epiphora owing to NLDO. Patients were subdivided into two groups: group A included 30 (50%) eyes of 25 patients who were subjected to endoscopic DCR, and group B included 30 (50%) eyes of 27 patients who were subjected to external DCR.Results In this study, the right eye was more commonly affected than left eye. The percentage of right eye affection was 53.3% and left eye affection was 33.3%%. Massive intraoperative bleeding in group A was seen in five (16.5%) cases, whereas in group B, massive intraoperative bleeding was noted in nine (29.7%) cases. The difference was statistically nonsignificant (P=0.617). The successful surgical outcome after 6 months was achieved in 28 (92.4%) of 30 patients for the endoscopic DCR and 26 (85.4%) of 30 patients for external DCR surgery. The difference was not statistically significant (P=0.604).Conclusion DCR is the standard treatment for NLDO. It can be performed by external or endoscopic approach. Both these approaches have minimal complications and comparable surgical outcome. However, endoscopic DCR is a safe, minimally invasive effective day-care technique with good aesthetic results.

Adjunctive techniques to dacryocystorhinostomy: an evidence-based review with recommendations.

Many adjunctive techniques exist for dacryocystorhinostomy (DCR), with varying levels of supportive evidence. Literature from PubMed, EMBASE, and Cochrane Databases was reviewed between January 1990 and January 2020 to examine evidence regarding the utility of adjunctive techniques to DCR, including mucosal flap preservation, concurrent septoplasty, stenting, topical mitomycin C (MMC), and 5-fluorouracil (5-FU), as well as perioperative antibiotics and steroids. Recommendations were made based on the evidence found. Seven adjunctive techniques used in DCR were examined. The literature supported concurrent septoplasty when septal deviation is present. Silicone stents are recommended for external DCR approaches. MMC use is optional in external DCR and revision cases. The literature does not support the routine use of silicone stents or MMC in primary endoscopic DCR. Mucosal flap preservation is optional, with evidence showing comparable results with or without utilization. The level of evidence is limited for topical 5-FU, as well as perioperative antibiotic and steroid use. Recommendations for adjunctive techniques to external and endoscopic DCR surgeries can be made based on the current literature. Higher-level studies are needed to better optimize perioperative approaches to DCR.

Endoscopic versus external dacryocystorhinostomy: temporal and regional trends in the United States Medicare population

ABSTRACTPurpose: Endoscopic surgeries, such as dacryocystorhinostomy (DCR), are increasingly performed for orbital and lacrimal conditions. This study describes and compares recent trends in endoscopic DCR with open, or external, DCR in the United States (US).Methods: Medicare-Part-B National Summary data files were analyzed from 2000 to 2015 for temporal and geographic trends in endoscopic and external DCR. Medicare Physician and Other Supplier public use files detailing provider information were collected and analyzed from 2012 to 2015.Results: Between 2000 and 2015, the number of external DCRs remained relatively unchanged (8008 to 7086, −0.7% average annual growth), while the number of endoscopic DCRs steadily increased (881 to 1674, 4.6% average annual growth). The greatest number of endoscopic DCRs were performed in the South Atlantic region, whereas the Mountain region had the greatest number per capita. From 2000 to 2015, the average payment per procedure for external DCR was $526.63, compared with $512.45 for endoscopic DCR. Of endoscopic DCRs performed from 2012 to 2015, 831 (79%) were performed by Ophthalmology, 184 (18%) were performed by Otolaryngology, and the remainder by other subspecialties.Conclusions: The number of endoscopic DCR surgeries increased over the last 15 years while the number of external DCR surgeries remained stable and continued to surpass endoscopic procedures. While ophthalmologists perform the overwhelming majority of endoscopic DCR, otolaryngologists are performing a growing number.