Dacryocystorhinostomy dcr, one of the major methods to treat dacryocystitis, is a procedure used to create a lacrimal drainage pathway into the nasal cavity. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity. Among the endoscopic dcr group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of followup. With the introduction of rigid nasal endoscopes in the 1970s and the advent of endoscopic sinus surgery, intranasal endoscopic dacryocystorhinostomy has come into existence. Pdf dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. Dec 22, 2015 dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. The anatomic patency rate was lower in the external group 60.
Endoscopic dcr is a minimally invasive procedure performed by ophthalmologists and otorhinolaryngologists to unblock tear ducts and correct other causes of decreased patency of the nasal passages. The modern external dcr, in which the lacrimal sac is opened directly into the nasal cavity, was first described in 1904 by toti. And when it is nasolacrimal duct, this procedure is required. Using local anaesthesia, external dcr is more difficult for patients to tolerate compared with endoscopic dcr. Dacryocystorhinostomy dcr for the treatment of nasolacrimal duct obstruction nldo has been practiced for over a century. A retrospective, comparative, randomized interventional study was conducted from january 2012 to december 20. The aim of study was to compare and analyze surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for the management of primary acquired nasolacrimal duct obstruction at tertiary care referral hospital in. To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy end dcr or external dacryocystorhinostomy ext dcr. Absence of an external scar, minimal morbidity and low complication rate have made endonasal dcr popular. The operation is very similar to external dcr, except there is no cut through the skin and no scar afterwards.
This study aimed to compare the results of ees dcr vsexternal dcr. Arash j amadi department of ophthalmology, division of oculoplastic surgery, university of washington. Comparison of external dacryocystorhinostomy with nonlaser. Pdf external and endoscopic dacryocystorhinostomy in. Dcrs performed by the traditional external approach ex dcr or by a nonlaser, nonendoscopic endonasal approach en dcr. Pdf on jan 1, 2015, rinky saha and others published endoscopic vs external approach dcr. Conventional dacryocystorhinostomy versus endonasal. Dacryocystorhinostomy dcr involves the creation of an alternative route for the drainage of tears between the lacrimal sac and nasal cavity, bypassing the nasolacrimal duct.
Dec 15, 2016 endonasal endoscopic dcr and external dcr in primary nasolacrimal duct obstruction the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The literature is replete with studies that purport the advantages of endoscopic endonasal dcr and includes greater cosmetic acceptability with no external scar, with 10% of patients with external dcr reporting a cosmetically unacceptable result. External dacryocystorhinostomy addeo toti first described external dcr in 1904, and with. In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more likely to accept such a revision without visible external cuts. Present surgical techniques to distal obstruction of the nasolacrimal duct system are the external dacryocystorhinostomy dcr and alternatively the endonasal laserassisted dcr and the transcanalicular laserassisted dcr. Jul 12, 2011 a comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of medicine, university of sydney, sydney, australiapurpose. Revision external dacryocystorhinostomy results after a. This surgery creates a new opening for tears to drain away from the eye. Fifty patients who underwent ext or end dcr between january 20102012. Advantages of endoscopic dcr it provides better aesthetic result with no external scar.
The study was designed prospectively as a nonrandomised comparative clinical trial to investigate the outcome of ees dcr vs ext dcr for acquired noncongenital partial ndo. Combining the own experiences and the overview of bibliography the different surgical techniques are compared. We are, therefore, more interested to 35 know whether performing en dcr in the setting of acute inflammation jeopardize the efficacy of. Jul 17, 2018 external dcr was found to have success rate of 97. For endoscopic dcr using the endoscopic approach, the ostium opens from the intended point. A clinical trial of endoscopic vs external dacryocystorhinostomy. Comparison of success rate of external dacryocystorhinostomy. Dcr external, dcr endoscopic eye surgery, tear duct. Comparison of success rate of external dacryocystorhinostomy with and without mitomycinc 936 p j m h s vol. External versus endoscopic dacryocystorhinostomy for. External dcr upper eye lid surgery watery eyes treatment. The primary and final outcomes of endoscopic and external. Research suggests the use of general anaesthesia 5 and, more recently, the use of local anaesthesia has also been proposed 8 for both techniques. Learning curve of the endoscopic procedure is a major limitation in enddcr applications against an easily applied extdcr procedure after a short self orientation time to lacrimal anatomy.
However endoscopic dcr was found to have minimal complication rate 11 30. Six of these previous failed dcrs were multidiode laser dcr, two of them were endoscopic dcr, and 33 were external dacryocystorhinostomy e dcr. Since the advent of the nasal endoscope, the transnasal endoscopic dcr has gained popularity and has several advantages over the external approach. Listing a study does not mean it has been evaluated by the u. This alternative route is generated using an external approach external dcr or through the nasal cavity using an endoscope eesdcr. Retrospective, comparative, nonrandomized clinical. Endonasal dcr broadly refers to the approach from inside the nose, including the speculum or endoscope view. Hammerchisel endoscopic dcr is practical, less traumatic, less timeconsuming, and cosmetically more convenient than the external approach. Mar 23, 2017 comparison of the 3 techniques of dcr 29. Although the endonasal approach was described perhaps prior to this 2 it is only in recent decades with the introduction and development of the endoscope, that attention has turned to endoscopic dcr for both primary procedures and to revise failures 6.
Moreover, in our population, en dcr is preferred 33 over external dcr, either as primary or secondary procedure, as unsightly scar with 34 postinflammatory hyperpigmentation is frequently an issue. The time to symptoms relief was statistical significantly shorter in en dcr group 1. Onerci stratified success rates according to experience of the surgeons and found high success rates of up to 94% with experienced surgeons, compared with inexperienced surgeons with success rates of only 58% 23. Totis technique of external dacryocystorhinostomy dcr has been the treatment of choice for epiphora due to nasolacrimal duct obstruction since 1904. The standard treatment is dacryocystorhinostomy dcr, with the gold standard being the external dcr. Primary vs secondary endoscopic dacryocystorhinostomy for. Dacryocystorhinostomy dcr surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora water running down the face. Apr, 2016 six of these previous failed dcrs were multidiode laser dcr, two of them were endoscopic dcr, and 33 were external dacryocystorhinostomy e dcr. The success rate for endoscopic endonasal dcr appears comparable to the external approach, especially for treatment of nasolacrimal duct obstruction, with a number of advantages over an external.
However, there is an abundance of nonrandomized studies suggesting that endoscopic dcr with the mechanical removal of bone is a viable alternative to external dcr, with comparable outcomes. However, it is difficult to compare the success rate for primary surgery between external dcr and endoscopic endonasal procedures, as there are few comparative studies. An external dacryocystorhinostomy abbreviated as external dcr, an operation performed for an obstruction in the nasolacrimal duct, is undertaken using a small incision on the side of the nose. Surgery can be performed to create a functioning tear drainage system where there is an obstruction to the tear duct causing a watery eye. In this procedure, a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. This study is a prospective interventional case series looking at the procedure, outcomes, adverse events, success rates and patient satisfaction with external and endonasal dcr surgery performed by a subspecialized surgeon in a lac. Endoscopic vs external dacryocystorhinostomycomparison. External versus endoscopic dacryocystorhinostomy for acquired.
Indicated in patients of epiphora due to chronic dacryocystitis. Comparison of endoscopic and external dacryocystorhinostomy for. A dcr operation can be performed in 2 different ways, with or without a scar, called external or endoscopic dcr respectively. Endoscopic dcr surgery with its discussed benefits warrants a place in the 21st century as a contender for primary treatment of nasolacrimal duct obstruction.
Nasolacrimal duct obstruction is caused by a variety of acquired and congenital etiologies. Compared with external dcr, endoscopic dcr is more. Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure. The secondary outcomes evaluated included the 1 efficacy of en dcr including anatomical success, defined as a well patent ostium and positive dye test in the nasal cavity during endoscopic examination at postoperative month 12, and functional success, defined as an absence of subjective epiphora at postoperative month 12 9 and 2 safety of. Endoscopic dcr is an effective and safe alternative to external dcr. In both approaches, the lacrimal sac mucosa is connected to the nasal mucosa above the level of the mechanical obstruction at the nasolacrimal duct. This study aimed to compare the results of ees dcr vsexternal dcr ext dcr in the treatment of partial ndo. The oculoplastic and ent literature has an abundance of articles describing the success rates of endoscopic vs. To compare the result and advantages of both endonasal endoscopic and external dcr. Surgical outcomes of endoscopic dacryocystorhinostomy. Endoscopic dcr endoscopic dcr is a minimally invasive procedure to unblock tear ducts. There was no statistically significant difference between them. Dacryocystorhinostomy dcr consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed. This study aims to look at this hypothesis further.
It is a bypass procedure that creates an anastomosis between the lacrimal sac and the nasal mucosa via a bony ostium. The apparent advantages of endonasal dcr over external dcr are its less invasive nature, shorter operative time and preservation of pump function of the orbicularis oculi muscle due to the absence of an external skin and orbicularis incision. Overall, 46 adults patients were identified from the subspecialist oculoplastic and lacrimal service who fulfilled the criteria. This nasolacrimal duct obstruction was typically treated using external dacryocystorhinostomy. When comparing outcomes of external dcr and endoscopic dcr, baseline characteristics differed in the following. This is an operation to form a new tear drain between the eye and the nose, when there has been a blockage. What is endoscopic dacryocystorhinostomy dcr surgery for. Bleeding was the most common immediate postoperative complication seen in 33. Endoscopic dcr is an effective and safe alternative to external dcr, with. Feb 24, 2016 indicated in patients of epiphora due to chronic dacryocystitis. The endoscopic endonasal approach was introduced in 1893 by caldwell,1 but only over the last decade have we seen the predictable high success rates like that of external dcr. In all re dcr procedures, silicone tube intubation was performed, and the tube was removed at least 6.
Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about differences. Pdf endoscopic and external dacryocystorhinostomy dcr. The aim of study was to compare and analyze surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for the management of primary acquired nasolacrimal duct. Endoscopic versus external approach dacryocystorhinostomy. It allows a onestage procedure to also correct associated nasal pathology that may be causative. Nasolacrimal duct dysfunction has many different etiologies. Endoscopic dcr is a good alternative method for external dcr surgery. Endoscopic dcr is also technically more difficult to learn, and the learning curve for the endoscopic procedure has been reported in several studies. Two approaches of dcr have been established, endoscopic and external dcr ex dcr and en dcr. Endoscopic surgery for lacrimal outflow obstruction is a safe and effective alternative to traditional external dacryocystorhinostomy dcr surgery in most patients, and offers the advantages of. Dacryocystorhinostomy dcr consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.
Jul 22, 2011 this study aimed to compare the results of eesdcr vsexternal dcr. Dacryocystorhinostomy dcr endoscopic versus external. A clinical trial of endoscopic vs external dacryocystorhinostomy for partial nasolacrimal duct obstruction. It preserves the pumping mechanism of the orbicularis oculi ms. Despite ease and decreased morbidity of endonasal dcr, external dcr is procedure of choice as it is more successful. External and endoscopic dacryocystorhinostomies have similar success rates. The nice benefit of the endoscopic approach is the.
Comparison of endoscopic and external dacryocystorhinostomy. Dcr can be performed through an external incision near the eyelid, or endoscopically purely through the nose without an external incision. Mar 14, 2017 dcr can be performed through an external incision near the eyelid, or endoscopically purely through the nose without an external incision. Endonasal endoscopic dcr and externaldcr in primary. Conventional dacryocystorhinostomy versus endonasal dacryocystorhinostomy.
Endoscopic dcr was found to have better patient satisfaction compared to external dcr. Overview endoscopic dacryocystorhinostomy guidance nice. In all re dcr procedures, silicone tube intubation was performed, and the tube was removed at least 6 months after surgery. Fifty patients who underwent ext or end dcr between january 20102012 were involved in the study. Dacryocystorhinostomy dcr is one possible tretment for blocked tear ducts. Endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. The national institute for health and clinical excellence nice has issued full guidance to the nhs in england, wales, scotland and northern ireland on endoscopic dacryocystorhinostomy. Access is through your nose, using a small thin camera endoscope.
This article tries to provide few tips to make dcr easy and stressfree. Although external dcr was considered to be the gold standard treatment for nld obstruction, endoscopic dcr appears to give comparable results, with the advantage of the absence of external facial scar and no disruption of the. Resolution of symptoms of watering in outdoor conditions was reported by 84% of the participants in the external dcr group and 59% of those in the laserassisted endonasal dcr group rr 0. In the past, external dacryocystorhinostomy dcr was considered as the gold standard treatment for nldo.
Based on the only randomized controlled trial, external dcr provides a superior outcome to endoscopic dcr with regard to symptoms at 1 year follow. The success rate of the endoscopic dcr procedure is comparable with that of traditional external dcr, and it also allows simultaneous correction of any intranasal pathology. Endoscopic laser dcr appears to be a safe and effective procedure which should be considered as an alternative to external dcr for the surgical treatment of. Dacryocystorhinostomy, endoscopic, epiphora, external. A comparative analysis find, read and cite all the research you need on researchgate. Dacryocystorhinostomy or dcr is one of the most common oculoplastics surgery performed. It avoids injury to the medial canthus scar formation. Patients in the external dcr group were significantly older median age, 51 versus 41 years. Dacryocystorhinostomy dcr has traditionally been performed vi. Endoscopic dacryocystorhinostomy dcr is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction nldo.
Endoscopic vs external dacryocystorhinostomycomparison from. Although external dcr was considered to be the gold standard treatment for nld obstruction, endoscopic dcr appears to give comparable results, with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. External versus endonasal dacryocystorhinostomy in a. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. It may be performed through an external skin incision or intranasally with or without endoscopic visualization. Endoscopic dcr with conventional instruments results and advantages over external dcr.
Postoperative diagnostic nasal endoscopy in an 82yearold female who underwent endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction. A comparison of endonasal dacryocystorhinostomy and external. When comparing outcomes of external dcr and endoscopic dcr table 2, baseline characteristics differed in the following. With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular. Endoscopic endonasal dcr plays an established role in revision dcr surgery. Also with the advent of nasal endoscopy, the endonasal. Endoscopic dacryocystorhinostomy for acquired nasolacrimal. Endoscopic and external dacryocystorhinostomy dcr which is better. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction nldo. Hensonthe safety and efficacy of mitomycin c in endonasal endoscopic laserassisted.
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