Endonasal Dacryocystorhinostomy, Our Experience

Toti first describe the external Dacryocystorhinostomy (DCR) in the early 20th century [1], the technique is applicable to patients complaining of tearing and demonstrating obstruction of the lacrimal outflow system. The procedure consists of creating a fistula directly from the lacrimal sac into the nose and bypassing the nasolacrimal duct. Caldwell first described the endonasal approach to the lacrimal sac [2], in 1893, and later in 1911 West introduce it [3], however, its use remained limited due to difficulties in visualizing the endonasal structures during the operation. The introduction of the microscopes and the rigid endoscopes provided the catalyst for endonasal Dacryocystorhinostomy (DCR). In our hospital (Tripoli medical center, Tripoli, Libya), we start this kind of surgery in collaboration with the Ophthalmological department in 2006. We present our experience with 32 patients underwent this operation. Materials and Methods A total of 32 patients with nasolacrimal duct obstruction were treated consecutively by microscopic and endoscopic endonasal DCR. All patients were females (100%). Patients ages ranged from 22 to 70 years. Patients were usually referred by an ophthalmologist with a history of epiphora and nasolacrimal duct obstruction, all patients has either sicca or post-saccal stenosis. There were 3 cases of Dacryocele, 4 cases needed nasal septal surgery and one patient with rhinolith needed removal of the nasal pathology during the surgery. Pre-operatively, a detailed clinical examination was carried out by an ophthalmologist and an ENT surgeon, including regurgitation testing and lacrimal syringing and probing. Endoscopic evaluation was performed in every case, in order to check for access, deviated nasal septum, turbinate hypertrophy or any other associated pathology. General anesthesia was used in all patients. Online Journal of Otolaryngology and Rhinology Open Access