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The nasolacrimal duct obstruction affects about 20% newborns. Most cases have a spontaneous resolution in the first year of life. Endoscopic dacryocystorhinostomy (DCR) is indicated when symptoms reoccur after conservative treatment. This retrospective study included 10 patients, from January 2015 to December 2019. Epiphora was the most frequent symptom (70%, n=7). Lacrimal stents were placed in 60% (n=6), with no intraoperative complications. There were 3 accidental extrusions, with an average stent stay of 5,6 months in the remaining patients. Surgical success was achieved in 100% of cases, with an average follow-up of 7 months. DCR is a simple surgical procedure with a low rate of complications. At pediatric age, it presents anatomical constraints with the need to adapt the endoscopic technique along a minimally invasive approach. The cooperation between Ophthalmology and Otorhinolaryngology is essential for the multidisciplinary treatment of these patients. A obstrução do canal lacrimonasal afecta cerca de 20% dos recém-nascidos. A maioria dos casos tem resolução espontânea no primeiro ano de vida. A dacriocistorrinostomia endoscópica está indicada quando há recidiva dos sintomas após tratamento conservador. Este estudo retrospectivo descritivo de Janeiro de 2015 a Dezembro de 2019 inclui 10 doentes submetidos a dacriocistorrinostomia endoscópica. A epífora foi o sintoma mais frequente (70%, n=7). Foram colocados stents na via lacrimal em 60% (n=6) dos doentes, sem complicações intra-operatórias. Registaram-se 3 extrusões acidentais, com uma média de permanência do stent nos restantes doentes de 5,6 meses. O sucesso cirúrgico foi atingido em 100% dos casos, com follow-up médio de 7 meses. A DCR é um procedimento cirúrgico simples com baixa taxa de complicações. Na idade pediátrica apresenta constrangimentos anatómicos com necessidade de adaptação da técnica endoscópica e abordagem minimamente invasiva. A colaboração Oftalmologia e Otorrinolaringologia é essencial no tratamento multidisciplinar destes doentes.

OBJECTIVES To compare the results of immediate endoscopic dacryocystorhinostomy (En-DCR) and delayed En-DCR in the treatment of new-onset acute dacryocystitis (AD). STUDY DESIGN This report describes a prospective randomized controlled interventional case series. METHODS Between April 2009 and May 2019, 176 adults presenting at a tertiary eye care center with new-onset AD manifesting within the last 48 hours were randomized into two groups. Altogether, 160 patients (48 male, 112 female) were included in this study, with a median age of 52.8 years (range: 18-82). Patients in group A underwent urgent En-DCR, although those in group B underwent a delayed En-DCR after 2 to 5 days of systematic antibiotic treatment. Variables compared between these two groups included the time for resolution of acute external inflammation, free lacrimal passage reconstruction (LPR) success rates, and complication rates. RESULTS Postoperative data were collected from 86 patients in group A and 74 patients in group B. Patients that underwent immediate En-DCR exhibited a quicker resolution of acute inflammation (P

BackgroundPeri-orbital surgical emphysema is a rare complication that can occur after lacrimal surgery. It has only been described in isolated cases, following external dacryocystorhinostomy (n = 2) and Lester Jones tube insertion (n = 1).MethodA retrospective, non-comparative case series was conducted of patients who developed surgical emphysema following endoscopic dacryocystorhinostomy.ResultsA total of 356 endoscopic dacryocystorhinostomy cases (primary, n = 316; revision, n = 40) were performed over a six-year period. Seven cases of post-operative surgical emphysema were identified, all of which were preceded by uncontrolled sneezing, nose-blowing or coughing within the first week of surgery. The occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy in our centre was 7 in 356, or 2 per cent, over six years.ConclusionThis is the first study to report the occurrence of surgical emphysema post-endoscopic dacryocystorhinostomy. Clinicians may wish to suggest patients stifle the aforementioned triggers within the first week to reduce the potential for surgical emphysema.

Cerebral palsy (CP) is a congenital syndrome with systemic manifestations secondary to a non-progressive lesion of the immature brain. It is associated with numerous cerebral and non-cerebral malformations. The present report describes a 2-year-old baby with spastic CP, diplegic type, associated with congenital cardiac malformations and right eye complex congenital nasolacrimal duct obstruction (CNLDO) (bony nasolacrimal duct stenosis and buried probe) requiring endoscopic dacryocystorhinostomy and left eye simple CNLDO which resolved on probing the system. This report also lays emphasis on the need for examination of the lacrimal drainage system in all patients with CP, so as to treat them appropriately and reduce the morbidity.

PURPOSE To assess the efficacy of radiofrequency-assisted endofistulectomy in patients with lacrimal fistulae communicating with the lacrimal sac. METHODS Retrospective interventional case series of patients undergoing endoscopic dacryocystorhinostomy with endofistulectomy from June 2016 to January 2020 were studied. The indications of endoscopic dacryocystorhinostomy were associated refractory complex congenital nasolacrimal duct obstructions and primary-acquired nasolacrimal duct obstruction. The communication of the fistulae with the lacrimal sac was ascertained. Specific surgical parameters and technique were used, and the variables assessed include patient demographics, clinical presentation, indications, surgical technique, recurrences, and outcomes. RESULTS Six eyes of 6 patients with mean age of 23.33 years underwent radiofrequency-assisted endofistulectomy. The surgical technique was found to be minimally invasive, easy to perform with multiple advantages like absence of a skin incision, targeting of the complete extent of the fistula, and complete closure of the external and internal openings of the fistulae. At 4 weeks, dacryocystorhinostomy ostium was well mucosalized and patent with a dynamic common canalicular opening. The fistula site had healed well with no epiphora or discharge or residual scarring. CONCLUSION Radiofrequency-assisted endofistulectomy is a minimally invasive and viable alternative to incisional fistulectomy in select group of patients of congenital or acquired fistulae which communicate with the lacrimal sac.

Background The nasal mucosa is sacrificed in conventional endoscopic dacryocystorhinostomies (EDCRs). Some surgeons, however, modify the technique by elevating a mucosal flap prior to creating the osteotomy with the aim of preserving the mucosa. To our knowledge, no clear-cut benefit of a mucosal flap has been established. The aim of this study is to examine the differences in surgical techniques and success rates of EDCRs with and without mucosal flap preservation. Methods We carried out a medical record review of all patients who underwent primary EDCR at the Goldschleger Eye Institute from October 2009 to October 2017. The following data were retrieved from the medical database and analyzed: patient demographics (age at diagnosis and gender), medical history, examination findings, surgical details, postoperative success, complications, and follow-up. Results A total of 107 patients who underwent 117 EDCRs participated in the study. Fifty-one patients comprised the group without a mucosal flap and 56 patients comprised the group with mucosal flap preservation. The medical history, presenting complaints, and preoperative examination findings were similar for both groups. The surgical success rate was not significantly different between the groups (82.1% without flap vs. 86.8% with flap, P = 0.478, Chi-square). Conclusion The findings of this comparison of EDCRs with and without mucosal flap preservation in a large patient population revealed no differences in surgical success or complications rates between the two procedures and, therefore, no benefit for adding flap preservation to conventional EDCRs.

Introduction 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. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search. Materials and Methods In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature. Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.

We report a rare case of metastasis to the nasolacrimal sac from colorectal carcinoma in a 69-year old man. Despite tumor removal and endoscopic dacryocystorhinostomy with stenting, the tumor recurred 3 months later, which was treated with chemotherapy and radiotherapy. Five months later, the patient eventually died from respiratory failure secondary to malignant pleural effusion.

Background: Congenital nasolacrimal duct obstruction is frequent and paediatric endonasal endoscopic dacryocystorhinostomy (DCR) is increasingly used after conservative treatment failure. Methodology: Retrospective noncomparative case series study was conducted from January 2007 to August 2017. Patients under 18 years old with nasolacrimal system obstruction who underwent endoscopic DCR were studied. All children were referred to our otorhinolaryngology department in a tertiary referral paediatric hospital. Population characteristics, presentation symptoms, success rate and predictive factors for failure were analysed. Results: 30 children were identified. Ages varied from 2 to 13 years old. Simultaneous bilateral surgery was performed in 5/30 (16,7%) children. Silicone stents were used in 93% of interventions with a mean time to removal of 9,6 weeks. Persistent epiphora was found in 43% of children and recurrent dacryocystitis in 57%. Success rate for primary DCR was 83,3%. Revision surgery was performed in 16,7% of cases. Minor complications rate was 13,3%. The presence of concomitant chronic nasal infections pointed for surgery failure reaching statistical significant value (p=0.0456). Conclusions: Paediatric endonasal endoscopic DCR seems to be an effective, safe and minimally invasive technique for the treatment of mechanical nasolacrimal system obstruction.

To evaluate the clinical usefulness of the dacryoscintigraphy in patients with nasolacrimal duct obstruction prior to endoscopic dacryocystorhinostomy. One hundred thirty-five lacrimal views of endoscopic dacryocystorhinostomy (DCR) with a single surgeon for primary nasolacrimal duct obstruction (PANDO) were included. These were assigned into three groups according to the type of dacryoscintigraphy. Group 1 was a pre-sac obstruction pattern. Group 2 was an intra-sac obstruction pattern. Group 3 was post-sac obstruction pattern. Each group was evaluated for an anatomical and functional surgical success, presence of complications including granuloma, synechiae, and tube-induced inflammation at least 12 months after the surgery. Both anatomical and functional success rate showed no significant difference among the three groups (P = .297 and .472 linear by linear association). Functional failure rate (functional failure/total failure) also showed no clinically significant differences between groups. Logistic regression analysis was performed to determine the factors associated with functional success. There were no statistically significant factors in age, sex, scintigraphy type, pre-operative endoscopic grade, post-operative granuloma, and synechiae. In patients with nasolacrimal duct obstruction, preoperative evaluation of obstruction level using dacryoscintigraphy may be not useful for predicting the functional success of the endoscopic dacryocystorhinostomy.

Purpose: To report a case of a lacrimal sac tumour identified at the time of endoscopic dacryocystorhinostomy and describe a swinging inferior turbinate approach to the nasolacrimal duct (NLD) to f...

Objective A growing body of evidence demonstrates that endonasal endoscopic dacryocystorhinostomy (eDCR) techniques provide comparable results to conventional external techniques. The purpose of this study was to evaluate long-term outcomes after powered endoscopic DCR without preservation of mucosal flaps for the management of acquired nasolacrimal duct obstruction performed by a single surgical team. Methods A retrospective review was performed of patients with epiphora secondary to acquired nasolacrimal duct obstruction who underwent eDCR without mucosal flap preservation from May 2003 to April 2013 at a tertiary referral medical center. Main outcome measures were subjective improvement in epiphora and assessment of anatomic patency based on lacrimal irrigation and endoscopic evaluation. Results Eighty patients (69 primary and 11 revision) totaling 103 procedures (87 primary, 16 revision) were available for analysis at a mean follow-up of 28.7 (range 6-114) months. At the most recent follow-up, 92 of 103 (89.3%) procedures had complete resolution of epiphora, and 10 of 103 procedures achieved mild intermittent epiphora. Complete resolution of epiphora was noted in 93.1% (81 of 87) of primary procedures and 68.8% (11 of 16) of revision procedures. Objective anatomic patency was confirmed in 98% (101 of 103). A revision procedure was required in 5.8% (6 of 103). Conclusion Outcomes of powered eDCR without the preservation of mucosal flaps compare favorably to previously reported results in the literature. These long-term results suggest that mucosal flap preservation is not required to achieve successful outcomes with eDCR. Level of evidence 4 Laryngoscope, 130:12-17, 2020.

Objectives To identify the relationship between surgical success rate and preoperative nasal mucosal thickness around the lacrimal sac fossa, as measured using computed tomography. Methods We reviewed 33 eyes from 27 patients who underwent endoscopic dacryocystorhinostomy after diagnosis of primary nasolacrimal duct obstruction and who were followed-up with for at least six months between 2011 and 2014. We measured preoperative nasal mucosal thickness around the bony lacrimal sac fossa using computed tomography and analyzed patient measurements after classifying them into three groups: the successfully operated group, the failed operation group, and the non-operated group. Results Surgery failed in six of the 33 eyes because of a granuloma at the osteotomy site and synechial formation of the nasal mucosa. The failed-surgery group showed a clinically significantly greater decrease in nasal mucosal thickness at the rearward lacrimal sac fossa compared with the successful-surgery group. However, nasal mucosal thickness of fellow eyes (i.e., non-operated eyes) was not significantly different between the two groups, and the location of the uncinate process did not appear to influence mucosal thickness. In the failed group, posteriorly located mucosal thickness of operated eye fossa was thinner than that of the non-operated eyes, but not significantly so. Conclusions Our results from this quantitative anatomical study suggest that nasal mucosal thickness is a predictor of endoscopic dacryocystorhinostomy results.

The following article reviews the clinical presentation, evaluation, and surgical treatment of patients with nasolacrimal duct obstruction, with an emphasis placed on the surgical techniques of external and internal/endoscopic dacryocystorhinostomy.

Purpose: To evaluate the effect of postoperative nasal triamcinolone spray use in primary endoscopic dacryocystorhinostomy using The Lacrimal Symptom Questionnaire .Methods: This study included a series of 50 consecutive retrospective cases with primary endoscopic dacryocystorhinostomy and with silicone stent implantation who were followed up for 6 months postoperatively. Patients using nasal triamcinolone spray for 3 months postoperatively were included in the triamcinolone group. Patients not using triamcinolone were included in the control group. Lacrimal stents were removed 3 months postoperatively. The Lacrimal Symptom Questionnaire (Lac-Q) was performed in the preoperative and postoperative 6th month. Anatomical success, functional success, and changes in lacrimal symptom and social impact scores were compared between the two groups 6 months after surgery.Results: Results of 48 endoscopic dacryocystorhinostomies performed on 48 patients (23 triamcinolone group, 25 control group) meeting the inclusion criteria were analyzed. The anatomical success rate (95.7% vs. 84.0%, p = 0.350) and the functional success rate (91.3% vs. 76.0%, p = 0.249) were higher in the triamcinolone group, but this difference was not statistically significant. No complications were observed in the triamcinolone group, whereas complications developed in two patients in the control group (p = 0.490). The mean change in total lac-Q score was 11.0 in the triamcinolone group and 9.0 in the control group (p = 0.011). The mean change in social impact score was 4.0 in the triamcinolone group and 3.0 in the control group (p = 0.005). Mean change in lacrimal symptom score was 6.0 in the triamcinolone group and 6.0 in the control group (p =0.368)Conclusions: Our study indicated that postoperative use of triamcinolone spray increases the success rate of endoscopic dacryocystorhinostomy. also revealed that triamcinolone may also lead to greater improvement in quality of life scores than the control group using a validated questionnaire.

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. Methods: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps &lt, 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

Purpose: To compare anatomical and functional success of Endonasal Dacryocystorhinostomy (DCR) with that of External Dacryocystorhinostomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Ophthalmology and Otolaryngology, District Headquarter Teaching Hospital, Sahiwal, from July 2018 to July 2019. Methods: Sixty patients with nasolacrimal duct obstruction were selected by convenient sampling technique and were divided into two groups. Group 1 underwent endonasal DCR while group 2 underwent external DCR. Detailed history with regard to symptoms and duration of the obstruction was taken. Detailed ophthalmological and otolaryngological examination was performed. Patients were followed up for three months. Chi-square test was used to compare the success between two groups. Confidence level of 95% was used and p value of less than 0.05 was considered significant. Results: Male to female ratio was 4:11. The most common presenting symptoms was epiphora that was present in all patients. Regurgitation of lacrimal sac was present in 75%, conjunctivitis was present in 53.33% and dacryocystitis was present in 41.66% patients. Anatomical success rate for endonasal DCR was 25 (83.33%) and for external DCR was 27 (90%). Functional success rate for endonasal DCR was 23 (76.67%) and for external DCR was 22 (73.33%). There was no statistically significant difference in the short term success of surgery between the two groups. Conclusion: Endonasal DCR offers minimal invasive approach with comparable anatomical and functional results to the external DCR. Key Words: Conjunctivitis, Dacryocystorhinostomy, Dacryocystitis, Epiphora.

The article presents modern methods of surgical treatment of chronic dacryocystitis, a brief historical review of various options for endonasal endoscopic dacryocystorhinostomy is carried out. The method of plastic seamless formation of dacryocystostomy, which does not require intubation of the lacrimal passages and/or using of silicone stoma dilators, is described. Between 2010 and 2019 at The State Budgetary Healthcare Institution of Moscow Area Moscow regional research clinical instituteВ статье представлены современные методы хирургического лечения хронического дакриоцистита, проведен краткий исторический обзор различных вариантов проведения эндоназальной эндоскопической дакриоцисториностомии. Описан метод пластического бесшовного формирования дакриоцистостомы, не требующий проведения интубации слезных путей и/или использования силиконовых дилататоров стомы. За период с 2010 по 2019 г. в ГБУЗ МО «МОНИКИ им. М.Ф. Владимирского» по разработанной методике были прооперированы 32 пациента (32 глаза) с хроническим дакриоциститом. Через 1 год после операции у всех пациентов зафиксирован положительный результат (отсутствие или значительное уменьшение слезотечения, хорошая визуализация дакриоцистостомы с хорошим пассажем слезы как пассивным, так и при промывании слезных путей).

Lacrimal sac mucopeptide concretions are not uncommon and usually identified following the lacrimal sac marsupialization during a dacryocystorhinostomy. A 39-year-old female presented with epiphora and discharge of 8 months duration and was diagnosed as primary acquired nasolacrimal duct obstruction. During the endoscopic dacryocystorhinostomy, a large intrasaccal polyp arising from the posterosuperior wall of the lacrimal sac with multiple inspissated mucopeptide concretions was noted. The lesion was excised, and the mucopeptide concretions were removed. Histopathology was suggestive of an intrasaccal polypoidal granuloma. To the best of the authors' knowledge, this is the first report of an intrasaccal polyp-like lesion secondary to a granulomatous response to a lacrimal sac mucopeptide concretion. It is important to be aware of this entity. The retrieval of mucopeptide concretion or lacrimal sac dacryoliths should prompt the surgeon to initiate an intraoperative endoscopic assessment of the sac before proceeding with the surgery.

PROPEL sinus implant (a) before use, (b) condensed together prior to loading, and (c) loaded into the inserter. (d) Final positioning of the implant at the site of the dacryocystorhinostomy ostiumA...

The study aims to compare the outcomes of endonasal endoscopic dacryocystorhinostomy (DCR) with and without nasolacrimal stents. A prospective randomized comparative study involving fifty patients, divided into two groups of 25 patients each. Group A consists of patients who underwent endoscopic DCR with silicon stent and group B consists of patients who underwent endoscopic DCR without stent. Patients were regularly followed up at 1st week, 6th week, 10th week and at the end of 5th month postoperatively. The silicone stents were removed at 6th postoperative week. Using statistical analysis results between the two groups were compared. Post-operative improvement in nasolacrimal duct obstruction and epiphora was seen in both the groups. Age of the patients ranged from 18 to 69 years with most of the patients in the age group of 40 to 49 years (46% N = 23, 12 in group A and 11 in group B). 88% of the patients were females. (N = 44, 21 in group A and 23 in group B) and 12% were males (N = 6, 4 in group A and 2 in group B). The disease was more commonly observed on the left side with 72% of the cases (N = 36, 19 in group A and 17 in group B) and 28% (N = 14, 6 in group A and 8 in group B) on the right side. In group A, (En DCR with silicone stent) 96% of the cases were successful while 4% resulted in failure whereas in group B (En DCR without stent) 92% of the cases were successful while 8% resulted in failure. Endoscopic DCR is simple and safe method. It is minimally invasive procedure as it is a direct approach to the sac. Cosmetically it is acceptable as there is no external scar. Endoscopic dacryocystorhinostomy with canalicular silicone intubation for shorter duration (6 weeks) is a safe and successful procedure for the treatment of nasolacrimal duct obstruction. Close follow up immediately after surgery is needed to reduce the failure rate. Regular post-operative follow up is necessary and any defect like synechia and granulation tissue formation can be released at follow up period thus increasing the success rate. En DCR has a good success rate with and without stenting of 96% and 92% respectively.

Background: Epiphora is defined as watering of the eye due to imperfect drainage of tears through lacrimal passages.It may result from a wide variety of causes, the commonest cause is nasolacrimal duct obstruction (NLDO), which may be congenital or acquired. Acquired NLDO may be primary or secondary.Dacryocystorhinostomy (DCR) is an operation that creates a lacrimal drainage pathway into the nasal cavity to facilitate drainage of the previously obstructed excreting system.Aim of the work: The aim of this study is to compare endoscopic DCR and balloon catheter dilation in treatment of nasolacrimal duct obstruction.Patients and methods; A Prospective randomized comparative Study was conducted on 30 patients .15 cases underwent endoscopic DCR while the other cases underwent balloon catheter dilation. Data were analyzed and compared using Z, Chi-square and Fisher exact test. Results: The balloon catheter dilatation is a safe and minimally invasive technique but the endoscopic DCR has a high success rate.Conclusion:The two techniques are acceptable alternatives. The choice of surgery should depend upon patient's preference and availability of resources.

Objective: This study aimed to evaluate the effect of nasal packing on the surgical success and postoperative complications of endoscopic dacryocystorhinostomy (EnDCR) without using stents and mucosal flaps. Methods: The retrospective study comprised of 75 eyes of 65 consecutive patients undergoing EnDCR with the biting and removing technique. The patients were assigned to 2 groups depending on whether the biodegradable synthetic polyurethane foam was used or not (the packing group, 34 eyes; the nonpacking group, 41 eyes). At least 6 months after the EnDCR, the postoperative outcomes including anatomical and functional successes, and the postoperative complications such as synechia, granuloma, and bleeding were compared between the packing and nonpacking groups. Results: Synechia was lower in the packing group (23.5% versus 24.4%) but it was not statistically significant (P = 0.93). There were also no significant differences in the granuloma and bleeding complications between the 2 groups (respectively, P = 0.72, P = 0.08). The success rates of anatomical and functional reached 88% in the packing group compared with 82.9%, and 75.6% in the nonpacking group (respectively, P = 0.74, P = 0.76). Conclusions: The present study findings suggest that both groups have no superiorities over each other in the surgical outcomes after the EnDCR. However, further randomized studies are recommended before the generalization can be made.

Nasolacrimal duct obstruction is commonly managed through dacryrocysorhinostomy (DCR), either through an external or endoscopic approach. Historically, the external approach was thought to have a higher success rate than the endoscopic approach. However, the literature now suggests that the endoscopic approach has comparable success with many advantages, such as avoidance of a cutaneous incision, preservation of the orbicularis oculi pump function, decreased operative time, and the ability to address concomitant intranasal pathology that may be contributing to the nasolacrimal duct obstruction, such as septal deviation or nasal polyposis. Despite the overall high success rate of both external and endoscopic DCR, there is an approximately 10% failure rate reported in the literature. These failures may be secondary to a variety of causes, such as inappropriate osteotomies, scarring, nasal pathology, functional failure, or proximal stenosis of the canalicular system. When failure occurs, revision endoscopic DCR or conjunctivodacryocystorhinostomy are important tools to readdress patient symptoms. When performed, meticulous surgical technique combined with a thorough knowledge of the anatomy of the nasolacrimal system is essential to optimize success.

Endoscopic dacryocystorhinostomy (DCR) is a common procedure used to treat nasolacrimal duct obstruction, with success rates reported above 90% and minimal complications. Scarring and granuloma formation are the most common reasons for surgical failure. Silicone stents are used by most providers to maintain patency of the rhinostomy during postoperative healing. However, evidence does not support a significant improvement in long-term patency. The duration of stenting is highly variable among providers, ranging from 4 weeks to 9 months. The reasoning behind a shorter duration of stenting is that healing is nearly complete at 4 to 6 weeks, and a longer duration facilitates granuloma formation. Adjuvant therapies such as application of mitomycin C or intralesional steroids have been also described as methods for maintaining patency. Mitomycin C may have a role in revisions and complex cases but is used less in primary DCR. Local steroid therapy has shown some promise in its ability to help maintain rhinostomy patency without introducing unwanted effects.

The aim of our study was to develop a method for determining the topographic and anatomical relationship of the lacrimal sac with the surrounding structures and to evaluate its effectiveness in planning and performing endonasal endoscopic dacryocystorhinostomy (EEDCR). The study group (1st group) consisted of 45 who underwent EEDCR according to our technique, the comparison group (2nd) included 36 patients who, after performing EEDCR developed by us, into the dacryorinostoma zone a polyvinyl chloride conductor was installed. In the control group (3rd) included 28 patients who EEDCR performed by the the generally accepted technique. To assess the informativeness of computed tomography (CT) techniques of the lacrimal ducts (LD) and the possibility of effective use of the obtained CT data, patients of the 1st and 2nd groups were divided into 2 subgroups: 1A and 2A were included patients whom CT LD was performed according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. Hyperpneumatization of agger nasi cells was detected in 14.7% of the examined, inflammatory pathology in the paranasal sinuses – in 38.5% (p> 0.05). The lacrimal fossa was located at the level of the anterior end of the middle turbinate (MT) in 39.4% of cases, anteriorly in 32.1%, and posteriorly in 14.7%. In 13.8% of cases, it was difficult to determine the ratio of the lacrimal fossa to the anterior end of the MT, these cases were in subgroups 1B, 2B and in group № 3 (p

PURPOSE To investigate the anatomical structure characteristics of the frontal process of the maxilla in the medial wall of the lacrimal drainage system for endoscopic dacryocystorhinostomy based on the cone-beam computed tomography images. METHODS One hundred eight sides of orbits were retrospectively evaluated in this study. The angulation and thickness of the frontal process of the maxilla in the medial wall of the lacrimal drainage system were measured and compared at 2 different levels: lacrimal sac level and nasolacrimal duct level. The vertical height between the 2 measurement levels was also measured. Data were compared between males and females. RESULTS The average angulation and thickness of the frontal process of the maxilla were found significantly larger at the lacrimal sac level than at the nasolacrimal duct level (83.1 ± 11.3° vs. 61.7 ± 10.9° and 2.7 ± 0.9 mm vs. 1.1 ± 0.4 mm) (p < 0.001). The vertical height between the 2 levels was significantly higher in males than in females (8.6 ± 1.8 mm vs. 7.8 ± 1.7 mm) (p = 0.015). CONCLUSIONS We found the angulation and thickness of the frontal process of the maxilla in the medial wall of the lacrimal drainage system decreased from the upper to the lower level. Starting the osteotomy during endoscopic dacryocystorhinostomy might be easier and safer at the midpoint level of the maxillary line.

Endoscopic endonasal dacryocystorhinostomy (END-DCR) has increased as a valid alternative to the classic external approach to treat distal lacrimal obstruction. Different surgical varieties of the END-DCR approach have been proposed with no clear understanding of the best surgical technique.A comprehensive research was performed in PubMed, Embase, SCOPUS, and Cochrane databases with a final search on March 2020.The aim of this search was to identify relevant END-DCR procedures performed with mechanical (Mecn-END-DCR) and powered (Pow-END-DCR) approaches to compare their functional success rate. In addition, the influence of mucosal flaps was evaluated. Articles were selected only if they were published later than 2000 and had at least 50 single-clinician surgical procedures performed. Excluded articles included acute infections, cancers, mixed cohort study, and revision cases.A total of 11,445 publications were identified and 2741 reviewed after screening; 15 articles were included after full-text review (0.6% of the initial articles reviewed). The mean success rate was 91.34% (95% CI, 87.1%-94.3%) for Pow-END-DCR and 89.5% (95% CI, 86.5%-91.9%) for Mecn-END-DCR with no significant difference between the surgical approaches (Our analyses suggest that there are no differences in outcomes between mechanical and powered approaches in END-DCR and that mucosal flap preservation is not essential to achieve a superior END-DCR outcome.

Background/Aim: Endoscopic dacryocystorhinostomy (EDCR) has many advantages over the external method, with comparable anatomical and functional success rates. Delayed wound healing is reported to be associated with older age in previous studies. In this study, we aimed to assess the effect of age on the functional and anatomic success of our EDCR results.Methods: A total of 55 patients with nasolacrimal duct obstruction (NLDO) were included in this retrospective cohort study. Patients were managed with either EDCR alone or EDCR combined with nasal septoplasty in our hospital. The patients were divided into two groups as Group 1 (20-54 years old) and Group 2 (55-77 years old) according to age. Results: The mean ages of the patients in Groups 1 and 2 were 38.53 (9.55) years and 66.24 (6.36) years, respectively (P

Endonasal dacryocystorhinostomy (DCR) is an effective modality for treating patients of nasolacrimal duct obstruction (NLD). However, failures do occur for various reasons including cicatricial closure of the ostium, common canalicular obstruction, distal canalicular obstruction, granulomas and neo osteogenesis [1–14]. Revision surgeries are challenging and each case is different. Intraoperative causes of failure include the difficulty in sac localization, inadequate and inappropriate bony window formation, uncorrected septal deviations and concha bullosa [1–14]. Correction of associated nasal pathologies must be done during revision endoscopic DCR. A thorough preoperative evaluation with proper surgical planning results in a successful surgery.

Trauma to the lacrimal sac and nasolacrimal duct (NLD) occurs as a result of mechanical injury and is often associated with facial trauma in 7–15% of cases [1, 2, 3]. It is also encountered during various endoscopic surgical procedures. Management of traumatic NLD obstruction is challenging unlike primarily acquired NLD obstruction as the anatomy of the bony lacrimal fossa and NLD is altered with lot of scarring and the surgery carries an increased risk of failure [2]. Some of the studies prefer external DCR and discourage endoscopic, endonasal or laser DCR in posttraumatic NLD obstruction due to the loss of bony anatomical landmarks after trauma and subsequent surgery [2]. However, in our experience, endoscopic DCR after a comprehensive preoperative evaluation including nasal endoscopy and CT DCG followed by safe and effective drilling in the superior part under direct endoscopic visualization leads to excellent results.

Endoscopic Dacryocystorhinostomy (DCR) is now a well-established procedure for the treatment of nasolacrimal duct obstruction with a success rate as high as 95.7% [1]. It involves creating a passage of the lacrimal sac into the nose by bypassing the obstruction in the nasolacrimal duct (NLD). It as is a safe, fast and effective method to relieve stenosis distal to the common canaliculus [2].The morbidity is less and bilateral endoscopic DCR can be done in the same sitting. Feasibility of endoscopic DCR in an acute dacryocystitis is the added advanvtage over external dacryocystorhinostomy. A meta-analysis compared both endoscopic and external DCR and found that the success rates of both routes are comparable [35].

Although the advent of high definition camera unit and endoscopes has enabled the surgeons to handle complicated cases with ease and excellent outcomes but failures do occur. Identifying difficult situations prior to surgery can significantly reduce failures. Maxillary bone dominant fossa, associated nasal condition, intraoperative findings of diverticulum, bleeding during surgery and a damaged lacrimal drainage system in posttraumatic cases are challenges that can be handled effectively with the modern-day technology and skill level.Although some of them can be picked up on computed tomography (CT) scan and computed tomographic dacryocystography (CT DCG) but since most of the time radiological investigations are not done in primary acquired nasolacrimal duct (NLD) obstruction cases, these findings are often missed. Preoperative planning and meticulous surgery by correcting all associated conditions during endoscopic DCR leads to excellent results.

Preoperative assessment of cases undergoing endoscopic DCR plays an important role in achieving excellent results. Epiphora is the most common symptom of nasolacrimal duct obstruction in patients needing endoscopic dacryocystorhinostomy (DCR). However, there are several etiological factors causing epiphora and their treatment differs according to the cause. Therefore, a comprehensive evaluation of patients presenting with epiphora is needed [1]. Probing and Irrigation forms the main stay of diagnosis and remains the single most important investigation to check the status of the lacrimal drainage system. Correct technique of probing needs to be learnt with complete knowledge of false stops that can often mislead the surgeon. Nasal endoscopy must be done preoperatively in all the cases. There is a definitive role of CT and CT DCG in medial canthal swelling and post-traumatic cases. Through assessment facilitates a meticulous primary surgery leading to excellent outcomes.

In this era of minimally invasive surgery, there has been a significant improvement in the technique of endoscopic DCR [2–5] owing to the evolution in surgical instruments, availability of high definition camera and endoscope unit along with an improvement in surgical skills. This chapter describes the fine details of various equipments needed during endoscopic DCR.

The most common indication for DCR in the paediatric age group is CNLDO. Other indications include Primary acquired nasolacrimal duct (NLD) obstruction, Post-traumatic NLD obstruction and syndromic cases with systemic anomalies and NLDO [1–5]. Paediatric endoscopic DCR requires more expertise due to small dimensions of the nasal cavity. Case selection is crucial in children as careful evaluation and inferior meatal examination prior to DCR (with or without the use of dual endoscopy) can obviate the need for endoscopic DCR in selected few cases.