Endoscopic Dacryocystorhinostomy (DCR) is indicated for patients diagnosed with lacrimal sac or nasolacrimal duct obstruction. This can be caused by chronic stenosis of the nasolacrimal duct and can be congenital or acquired. Presenting symptoms include excessive epiphora (tearing) and dacryocystitis (infection). There seems to be a greater prevalence in elderly women than men.
Endoscopic DCR is a minimally invasive procedure used to bypass the nasolacrimal duct. It can be performed using either surgical instruments or a laser.
The patient is positioned in a supine position with the head turned slightly to the right side. A decongestant is administered to clear the nasal passage first and then gauze, soaked with anaesthesia that numbs the area and constricts blood vessels, is endonasally inserted to the medial eyelid, lacrimal fossa and nasal mucosa for ten minutes to maintain haemostasis and anaesthesiaintraoperatively.
A rigid endoscope, is inserted into the nasal cavity to the lacrimal sac via the lacrimal duct to explore and confirm the nature of the obstruction. The nasal mucous membrane is incised and removed, to allow for the creation of a window on the lacrimal sac and upper nasolacrimal duct. A portion of the lacrimal and maxilla bone is removed and an incision made in the lacrimal sac and nasolacrimal duct. Silicone tubes can be inserted to assist long-term patency.
Endoscopic DCR has the following potential advantages over the standard external DCR approach.
- The main advantage is that of avoiding facial cosmetic scars between the eye and nose by approaching into the nasal cavity.
- Local anaesthetic usually used in compliant patients.
- Accessing the rhinostomy directly limits tissue damage, surgical trauma and angular vein damage, preserving the canthal anatomy.
- Diagnosis and management of predisposing or concomitant nasal and paranasal disorders that may contribute to nasolacrimal obstruction – simultaneous treatment in one sitting.
- Bilateral cases are performed simultaneously.
- Immediate mistakes revised at surgery
- The possibility of failures being endoscopically investigated.
- Active dacryocystitis (nasal infection) is not a contraindication as with external approach.
- Reduced operating time.
- Reduced intraoperative bleeding.
- Reduced morbidity.
- Performed as day care surgery.