Dacryocystorhinostomy
Dacryocystorhinostomy (DCR) is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.
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DCR restores tear flow into the nose when the nasolacrimal duct does not function
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is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function
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Traditional approach involves an incision on the side of the nose with bone removal
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A small incision is made on the side of the nose and some bone is removed to make a connection to the nose
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Endoscopic approach offers lesser peri-operative morbidity and no scar but may have slightly lower success rate
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The advantages include lesser peri-operative morbidity, and no scar. Data suggests a slightly lower success rate than the "traditional" technique
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Antimetabolites may be used adjunctively to improve success rates
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Antimetabolites have been used with intent to increase the success rates of dacryocystorhinostomy
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Traditional technique: incision on side of nose, bone removed, drains left for months, Jones or Crawford tube placed; lacrimal sacs must be avoided
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A small incision is made on the side of the nose and some bone is removed to make a connection to the nose. Drains are left behind to prevent the gap from becoming closed and are removed after a few months. A Jones or Crawford tube is placed to facilitate the flow of tears from the eye to the nose. The lacrimal sacs must be avoided during this surgical procedure.
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Endoscopic technique: performed through the nose with an opening fashioned in the lacrimal sac from within
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The operation can also be performed endoscopically through the nose where an opening is fashioned in the lacrimal sac from within the nose
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Endoscopic DCR uses nasal endoscope to visualise the sac, nibbles out covering bone, and incises or excises the medial wall of the sac
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a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. The bone covering the lacrimal sac is nibbled out. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity
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Adjunctive antimetabolites may improve functional and anatomic results at follow-up beyond six months with only minor side effects
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At a follow-up time of more than six months, antimetabolites may improve functional and anatomic results. The use of antimetabolites had only minor side effects
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Atrophic rhinitis is an absolute contraindication
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Atrophic rhinitis is an absolute contraindication
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In acute dacryocystitis, the operation cannot be done immediately but is delayed
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In case of acute dacryocystitis, this operation can not be done immediately, rather it is done after a period of time
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In elderly patients above 70 years, dacryocystectomy is preferred over DCR due to age-related nasal mucosa atrophy
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In case of elderly patients (above 70 years of age), dacryocystectomy is preferred to dacryocystorhinostomy as old age naturally causes atrophy in nasal mucosa
Endoscopic DCR has a slightly lower success rate than the traditional technique; adjunctive antimetabolites may improve functional and anatomic results.
| Dacryocystorhinostomy | |
|---|---|
Left orbicularis oculi, seen from behind. | |
| ICD-9-CM | 09.81 |
| MeSH | |
Dacryocystorhinostomy (DCR) is a surgical procedure to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.[1]
Traditional
A small incision is made on the side of the nose and some bone is removed to make a connection to the nose. Drains are left behind to prevent the gap from becoming closed and are removed after a few months. A Jones or Crawford tube is placed to facilitate the flow of tears from the eye to the nose. The lacrimal sacs must be avoided during this surgical procedure.[citation needed]
Endoscopic
The operation can also be performed endoscopically through the nose where an opening is fashioned in the lacrimal sac from within the nose. The advantages include lesser peri-operative morbidity, and no scar. Data suggests a slightly lower success rate than the "traditional" technique.[citation needed]
With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular. In this procedure, a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. The bone covering the lacrimal sac is nibbled out. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity. This procedure avoids scarring.[citation needed]
Adjunctive use of antimetabolites
Antimetabolites have been used with intent to increase the success rates of dacryocystorhinostomy. At a follow-up time of more than six months, antimetabolites may improve functional and anatomic results. The use of antimetabolites had only minor side effects.[2]
Atrophic rhinitis is an absolute contraindication. In case of acute dacryocystitis, this operation can not be done immediately, rather it is done after a period of time. In case of elderly patients (above 70 years of age), dacryocystectomy is preferred to dacryocystorhinostomy as old age naturally causes atrophy in nasal mucosa.[citation needed]
- ↑ Ullrich K, Malhotra R, Patel BC (2021). "Dacryocystorhinostomy". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32496731. Retrieved 7 January 2022.
- ↑ Phelps PO, Abariga SA, Cowling BJ, Selva D, Marcet MM, et al. (Cochrane Eyes and Vision Group) (April 2020). "Antimetabolites as an adjunct to dacryocystorhinostomy for nasolacrimal duct obstruction". The Cochrane Database of Systematic Reviews. 4 (4) CD012309. doi:10.1002/14651858.CD012309.pub2. PMC 7138426. PMID 32259290.