Endoscopic Dacryocystorhinostomy as Treatment for Lower Lacrimal Pathway Obstructions in Adults: Review Article

Abstract

Obstruction of the lacrimal pathway is manifested by epiphora, infection, and blurred vision as well as ocular and facial pain. Conservative treatments only achieve temporary relief of symptoms, thus surgery is the treatment of choice. Dacryocystorhinostomy (DCR) is recognized as the most suitable treatment for patients with obstructions of the lacrimal system at the level of the sac or in the nasolacrimal duct. The aim of this operation is to create a bypass between the lacrimal sac and the nasal cavity. During the past 2 decades, advances in rigid endoscopic equipment and other instruments have made it possible to obtain more information about the anatomic landmarks of the nasolacrimal system, which led to the development of less-invasive and safer endoscopic techniques. However, many parts of the treatment process related to endoscopic endonasal dacryocystorhinostomy (EN-DCR) still remain controversial. This article reviews the published literature about the technical issues associated with the success of EN-DCR, and clarifies the pros and cons of different pre- and postoperative procedures in adults with lower lacrimal pathway obstructions.

Endoscopic dacryocystorhinostomy: Comparison of the effectiveness of using sickle knife-micro osteotome and monopolar cautery-Kerrison punch

“…Geç dönem komplikasyonların ise çoğu 1-3 ay arasında ortaya çıkar. Literatürde geç dönem komplikasyonları arasında rinostomada skar dokusu gelişimi, ostiyum içinde granülasyon dokusu oluşumu, rinostoma ile orta konka veya septum arasında ve orta konka ile septum arasında sineşi gelişimi belirtilmiştir 12 .…”

“…Bunun yanında silikon tüp uygulamasının granülas-yon dokusu oluşumunu arttırdığını ve başarı oranlarını düşürdüğünü belirten çalışmalar da vardır [21][22][23] . Özellikle revizyon vakalarda, küçük ve skarlı keselerde ve dar kanalikülü olan hastalarda tüp uygulaması önerilmektedir 12,24 . Çalışmamızda tüm vakalarda silikon tüp uygulaması yapıldı ve başarı oranımız literatürle uyumlu olarak %88 olarak bulundu.…”

Limited endoscopic high septoplasty prior to endonasal dacryocystorhinostomy: Our experience of nine cases

“…Primary acquired nasolacrimal duct obstruction is a clinical syndrome of unknown cause, manifested by epiphora, infection, blurred vision, and ocular and facial pain . Conservative care is usually ineffective in patients with chronic conditions; thus, dacryocystorhinostomy (DCR) has become the gold standard of treatment for such patients .…”

A Study of Endoscopic Endonasal Dacrocystorhinostomy With Mucosal Flap Technique

“…This allows tears to drain directly into the nasal cavity from the canaliculi via a new low-resistance pathway. 1 The endoscopic DCR has distinct advantage over the external DCR as there is no facial scar. Besides, the endoscopic DCR also maintains the pump action.…”