TRANSNASAL ENDOSCOPIC SURGERY - Dr. P. THULASI DAS
ENDOSCOPIC DCR FOR CHRONIC AND ACUTE DACRYOCYSTITIS
The eye is kept moist by the tears produced by the lacrimal gland. The excess tears drain into the nose through the lacrimal drainage system. Some times there is a block in the nasolacrimal duct and the tears get collected in the lacrimal sac which is situated in the corner of the eye near the nose and there is excessive watering from the eye. Sometimes this lacrimal sac gets infected and there is enlargement of the sac with disfigurement of the face. To correct this problem a new passage is created between the lacrimal sac and the nose, through an incision made on the face between the eye & the nose; an operation called External DCR. This has been the standard operation for the last 90 years. But now, this passage is created through the nose, using Endoscopic techniques. In children & women, this operation is a boon, since it avoids an external scar.
Acute dacryocystitis with abscess threatening to burst anytime; external DCR is impossible in this situation
Endoscopic dacryocystorhinostomy (DCR) is the operation of choice when there is acute abscess of the lacrimal sac with unhealthy skin, since the approach is through the nose, both drainage and rhinostomy can be done in one operation. At Sinus and Nose we have done over a thousand Endoscopic DCR operations, probably one of the largest series. Today, we do flap DCR which gives 98% success rate. We avoid stents in lacrimal sac surgery! Stents are put in, mostly because of surgeon’s anxiety. We are of the opinion that stents give trouble rather than improve results.