Endonasal dcr broadly refers to the approach from inside the nose, including the speculum or endoscope view. Dec 15, 2016 endonasal endoscopic dcr and external dcr in primary nasolacrimal duct obstruction the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Comparison of endoscopic and external dacryocystorhinostomy. An external dacryocystorhinostomy abbreviated as external dcr, an operation performed for an obstruction in the nasolacrimal duct, is undertaken using a small incision on the side of the nose. Dacryocystorhinostomy dcr consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. However, it is difficult to compare the success rate for primary surgery between external dcr and endoscopic endonasal procedures, as there are few comparative studies. Six of these previous failed dcrs were multidiode laser dcr, two of them were endoscopic dcr, and 33 were external dacryocystorhinostomy e dcr. This article tries to provide few tips to make dcr easy and stressfree. Endoscopic and external dacryocystorhinostomy dcr which is better.
Comparison of success rate of external dacryocystorhinostomy. This study aimed to compare the results of ees dcr vsexternal dcr. In all re dcr procedures, silicone tube intubation was performed, and the tube was removed at least 6. A dcr operation can be performed in 2 different ways, with or without a scar, called external or endoscopic dcr respectively. Also with the advent of nasal endoscopy, the endonasal. Compared with external dcr, endoscopic dcr is more. In all re dcr procedures, silicone tube intubation was performed, and the tube was removed at least 6 months after surgery. Based on the only randomized controlled trial, external dcr provides a superior outcome to endoscopic dcr with regard to symptoms at 1 year follow.
Dacryocystorhinostomy dcr surgery is a procedure that aims to eliminate fluid and mucus retention within the lacrimal sac, and to increase tear drainage for relief of epiphora water running down the face. The study was designed prospectively as a nonrandomised comparative clinical trial to investigate the outcome of ees dcr vs ext dcr for acquired noncongenital partial ndo. Jul 22, 2011 this study aimed to compare the results of eesdcr vsexternal dcr. This study aims to look at this hypothesis further. Dacryocystorhinostomy dcr has traditionally been performed vi. Mar 14, 2017 dcr can be performed through an external incision near the eyelid, or endoscopically purely through the nose without an external incision.
Endoscopic vs external dacryocystorhinostomycomparison. Dacryocystorhinostomy dcr, one of the major methods to treat dacryocystitis, is a procedure used to create a lacrimal drainage pathway into the nasal cavity. Both kerrison punch and drill are widely used in endoscopic dcr with nonconclusive knowledge about differences. Pdf endoscopic and external dacryocystorhinostomy dcr. Two approaches of dcr have been established, endoscopic and external dcr ex dcr and en dcr. A clinical trial of endoscopic vs external dacryocystorhinostomy for partial nasolacrimal duct obstruction. It preserves the pumping mechanism of the orbicularis oculi ms. Conventional dacryocystorhinostomy versus endonasal dacryocystorhinostomy. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Dec 22, 2015 dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction. For endoscopic dcr using the endoscopic approach, the ostium opens from the intended point. A comparative analysis find, read and cite all the research you need on researchgate.
This study aimed to compare the results of ees dcr vsexternal dcr ext dcr in the treatment of partial ndo. Endoscopic dcr is a minimally invasive procedure performed by ophthalmologists and otorhinolaryngologists to unblock tear ducts and correct other causes of decreased patency of the nasal passages. A comparison of endonasal dacryocystorhinostomy and external. Learning curve of the endoscopic procedure is a major limitation in enddcr applications against an easily applied extdcr procedure after a short self orientation time to lacrimal anatomy. Endoscopic dcr with conventional instruments results and advantages over external dcr. The aim of study was to compare and analyze surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for the management of primary acquired nasolacrimal duct. Endoscopic versus external approach dacryocystorhinostomy. Although the endonasal approach was described perhaps prior to this 2 it is only in recent decades with the introduction and development of the endoscope, that attention has turned to endoscopic dcr for both primary procedures and to revise failures 6.
Revision external dacryocystorhinostomy results after a. However endoscopic dcr was found to have minimal complication rate 11 30. The success rate of the endoscopic dcr procedure is comparable with that of traditional external dcr, and it also allows simultaneous correction of any intranasal pathology. Overview endoscopic dacryocystorhinostomy guidance nice. Dacryocystorhinostomy or dcr is one of the most common oculoplastics surgery performed. Endoscopic dcr is also technically more difficult to learn, and the learning curve for the endoscopic procedure has been reported in several studies. Endonasal endoscopic dcr and externaldcr in primary.
Endoscopic dcr endoscopic dcr is a minimally invasive procedure to unblock tear ducts. Bleeding was the most common immediate postoperative complication seen in 33. Patients in the external dcr group were significantly older median age, 51 versus 41 years. To compare the result and advantages of both endonasal endoscopic and external dcr. This study is a prospective interventional case series looking at the procedure, outcomes, adverse events, success rates and patient satisfaction with external and endonasal dcr surgery performed by a subspecialized surgeon in a lac. Hammerchisel endoscopic dcr is practical, less traumatic, less timeconsuming, and cosmetically more convenient than the external approach. The success rate for endoscopic endonasal dcr appears comparable to the external approach, especially for treatment of nasolacrimal duct obstruction, with a number of advantages over an external. Surgical outcomes of endoscopic dacryocystorhinostomy. Access is through your nose, using a small thin camera endoscope. Absence of an external scar, minimal morbidity and low complication rate have made endonasal dcr popular. Comparison of success rate of external dacryocystorhinostomy with and without mitomycinc 936 p j m h s vol.
Endoscopic endonasal dcr plays an established role in revision dcr surgery. Apr, 2016 six of these previous failed dcrs were multidiode laser dcr, two of them were endoscopic dcr, and 33 were external dacryocystorhinostomy e dcr. Indian journal of otolaryngology and head and neck surgery 2008. It avoids injury to the medial canthus scar formation. In both approaches, the lacrimal sac mucosa is connected to the nasal mucosa above the level of the mechanical obstruction at the nasolacrimal duct. Dacryocystorhinostomy dcr involves the creation of an alternative route for the drainage of tears between the lacrimal sac and nasal cavity, bypassing the nasolacrimal duct. Fifty patients who underwent ext or end dcr between january 20102012. Feb 24, 2016 indicated in patients of epiphora due to chronic dacryocystitis. The apparent advantages of endonasal dcr over external dcr are its less invasive nature, shorter operative time and preservation of pump function of the orbicularis oculi muscle due to the absence of an external skin and orbicularis incision. Endoscopic dcr is a good alternative method for external dcr surgery. Endoscopic dacryocystorhinostomy dcr is a recognized procedure performed to treat epiphora caused by anatomical or functional obstruction of the nasolacrimal apparatus. Comparison of endoscopic and external dacryocystorhinostomy for.
It may be performed through an external skin incision or intranasally with or without endoscopic visualization. To compare the success and complication rates, duration of surgeries and clinical comfort after endoscopic dacryocystorhinostomy end dcr or external dacryocystorhinostomy ext dcr. Although external dcr was considered to be the gold standard treatment for nld obstruction, endoscopic dcr appears to give comparable results, with the advantage of the absence of external facial scar and no disruption of the. Mar 23, 2017 comparison of the 3 techniques of dcr 29. External dcr upper eye lid surgery watery eyes treatment. This surgery creates a new opening for tears to drain away from the eye. The national institute for health and clinical excellence nice has issued full guidance to the nhs in england, wales, scotland and northern ireland on endoscopic dacryocystorhinostomy. Despite ease and decreased morbidity of endonasal dcr, external dcr is procedure of choice as it is more successful. Resolution of symptoms of watering in outdoor conditions was reported by 84% of the participants in the external dcr group and 59% of those in the laserassisted endonasal dcr group rr 0.
Endoscopic dacryocystorhinostomy dcr is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction nldo. Combining the own experiences and the overview of bibliography the different surgical techniques are compared. Dcr can be performed through an external incision near the eyelid, or endoscopically purely through the nose without an external incision. Nasolacrimal duct dysfunction has many different etiologies. This is an operation to form a new tear drain between the eye and the nose, when there has been a blockage. External versus endoscopic dacryocystorhinostomy for acquired. It is a bypass procedure that creates an anastomosis between the lacrimal sac and the nasal mucosa via a bony ostium. External versus endoscopic dacryocystorhinostomy for. Endoscopic laser dcr appears to be a safe and effective procedure which should be considered as an alternative to external dcr for the surgical treatment of. Moreover, in our population, en dcr is preferred 33 over external dcr, either as primary or secondary procedure, as unsightly scar with 34 postinflammatory hyperpigmentation is frequently an issue. Indicated in patients of epiphora due to chronic dacryocystitis.
Endoscopic surgery for lacrimal outflow obstruction is a safe and effective alternative to traditional external dacryocystorhinostomy dcr surgery in most patients, and offers the advantages of. Dcr external, dcr endoscopic eye surgery, tear duct. Dacryocystorhinostomy dcr consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed. Endoscopic dcr is an effective and safe alternative to external dcr, with. Endoscopic dcr is an effective and safe alternative to external dcr. The oculoplastic and ent literature has an abundance of articles describing the success rates of endoscopic vs. However, there is an abundance of nonrandomized studies suggesting that endoscopic dcr with the mechanical removal of bone is a viable alternative to external dcr, with comparable outcomes. Endoscopic dcr was found to have better patient satisfaction compared to external dcr. External versus endonasal dacryocystorhinostomy in a. Jul 12, 2011 a comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction r karim, r ghabrial, tf lynch, b tangschool of public health, faculty of medicine, university of sydney, sydney, australiapurpose. A retrospective, comparative, randomized interventional study was conducted from january 2012 to december 20. The literature is replete with studies that purport the advantages of endoscopic endonasal dcr and includes greater cosmetic acceptability with no external scar, with 10% of patients with external dcr reporting a cosmetically unacceptable result. The secondary outcomes evaluated included the 1 efficacy of en dcr including anatomical success, defined as a well patent ostium and positive dye test in the nasal cavity during endoscopic examination at postoperative month 12, and functional success, defined as an absence of subjective epiphora at postoperative month 12 9 and 2 safety of. Arash j amadi department of ophthalmology, division of oculoplastic surgery, university of washington.
Postoperative diagnostic nasal endoscopy in an 82yearold female who underwent endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction. In the past, external dacryocystorhinostomy dcr was considered as the gold standard treatment for nldo. Several ophthalmologists fear performing dcr because of bleeding and unfamiliarity of structure. Nasolacrimal duct obstruction is caused by a variety of acquired and congenital etiologies. The nice benefit of the endoscopic approach is the. Dacryocystorhinostomy, endoscopic, epiphora, external. A clinical trial of endoscopic vs external dacryocystorhinostomy. It allows a onestage procedure to also correct associated nasal pathology that may be causative. When comparing outcomes of external dcr and endoscopic dcr table 2, baseline characteristics differed in the following. Dacryocystorhinostomy dcr for the treatment of nasolacrimal duct obstruction nldo has been practiced for over a century. Pdf dacrocystorhinostomy dcr is an operation used to treat nasolacrimal duct obstruction.
Using local anaesthesia, external dcr is more difficult for patients to tolerate compared with endoscopic dcr. Fifty patients who underwent ext or end dcr between january 20102012 were involved in the study. Onerci stratified success rates according to experience of the surgeons and found high success rates of up to 94% with experienced surgeons, compared with inexperienced surgeons with success rates of only 58% 23. Pdf on jan 1, 2015, rinky saha and others published endoscopic vs external approach dcr. The endoscopic endonasal approach was introduced in 1893 by caldwell,1 but only over the last decade have we seen the predictable high success rates like that of external dcr. With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular.
Pdf external and endoscopic dacryocystorhinostomy in. The modern external dcr, in which the lacrimal sac is opened directly into the nasal cavity, was first described in 1904 by toti. Since the advent of the nasal endoscope, the transnasal endoscopic dcr has gained popularity and has several advantages over the external approach. Retrospective, comparative, nonrandomized clinical. To compare success rates of external dacryocystorhinostomy dcr and endoscopic endonasal dcr for acquired nasolacrimal duct obstruction nldo.
In the case of cicatricial obstruction at the osteotomy site, it is easier to perform endoscopic revision, and the patient is more likely to accept such a revision without visible external cuts. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity. We are, therefore, more interested to 35 know whether performing en dcr in the setting of acute inflammation jeopardize the efficacy of. Primary vs secondary endoscopic dacryocystorhinostomy for.
Jul 17, 2018 external dcr was found to have success rate of 97. Although external dcr was considered to be the gold standard treatment for nld obstruction, endoscopic dcr appears to give comparable results, with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. Comparison of external dacryocystorhinostomy with nonlaser. Dcrs performed by the traditional external approach ex dcr or by a nonlaser, nonendoscopic endonasal approach en dcr. Hensonthe safety and efficacy of mitomycin c in endonasal endoscopic laserassisted. The time to symptoms relief was statistical significantly shorter in en dcr group 1. Present surgical techniques to distal obstruction of the nasolacrimal duct system are the external dacryocystorhinostomy dcr and alternatively the endonasal laserassisted dcr and the transcanalicular laserassisted dcr. Advantages of endoscopic dcr it provides better aesthetic result with no external scar. Conventional dacryocystorhinostomy versus endonasal. The standard treatment is dacryocystorhinostomy dcr, with the gold standard being the external dcr. This alternative route is generated using an external approach external dcr or through the nasal cavity using an endoscope eesdcr. Dacryocystorhinostomy dcr endoscopic versus external. This nasolacrimal duct obstruction was typically treated using external dacryocystorhinostomy. What is endoscopic dacryocystorhinostomy dcr surgery for.
Listing a study does not mean it has been evaluated by the u. Research suggests the use of general anaesthesia 5 and, more recently, the use of local anaesthesia has also been proposed 8 for both techniques. And when it is nasolacrimal duct, this procedure is required. In this procedure, a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. Dacryocystorhinostomy dcr is one possible tretment for blocked tear ducts. Overall, 46 adults patients were identified from the subspecialist oculoplastic and lacrimal service who fulfilled the criteria.
Totis technique of external dacryocystorhinostomy dcr has been the treatment of choice for epiphora due to nasolacrimal duct obstruction since 1904. Among the endoscopic dcr group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of followup. The primary and final outcomes of endoscopic and external. External and endoscopic dacryocystorhinostomies have similar success rates. With the introduction of rigid nasal endoscopes in the 1970s and the advent of endoscopic sinus surgery, intranasal endoscopic dacryocystorhinostomy has come into existence. The aim of study was to compare and analyze surgical success and patient satisfaction in doing external dacryocystorhinostomy and endonasal endoscopic dacryocystorhinostomy for the management of primary acquired nasolacrimal duct obstruction at tertiary care referral hospital in. When comparing outcomes of external dcr and endoscopic dcr, baseline characteristics differed in the following. Endoscopic vs external dacryocystorhinostomycomparison from. The anatomic patency rate was lower in the external group 60. Endoscopic dacryocystorhinostomy for acquired nasolacrimal. Surgery can be performed to create a functioning tear drainage system where there is an obstruction to the tear duct causing a watery eye. External dacryocystorhinostomy addeo toti first described external dcr in 1904, and with. The operation is very similar to external dcr, except there is no cut through the skin and no scar afterwards. There was no statistically significant difference between them.