A comparative study of external and endonasal dacryocystorhinostomy in the management of chronic dacryocystitis

Background: Epiphora due to chronic dacryocystitis is extremely common in the ophthalmolmic practice across this country. The typical patient is often a female in her young or middle age, and the clinical pathology is usually obstruction of the naso lacrimal pathway located at the naso-lacrimal duct or beyond. Definitive treatment entails creation of an alternative pathway for fluid egress by a surgical procedure known as dacryocystorhinostomy (DCR). Aims and Objectives: To compare two commonly performed techniques of DCR – namely external and endonasal – in terms of surgical time, complications and outcomes. Materials and Methods: Seventy two patients were studied over a period of two years from April 2017 to May 2019 were divided in two equal groups. The first group (Group A, n=36) underwent external DCR which was done by an ophthalmic surgeon whereas the second group (Group B, n= 36) underwent endonasal DCR done by an ENT surgeon. All cases of both the groups were followed up for a period of six months. Both groups were compared in terms of surgical time, per and post operative complications and final surgical outcomes. Results: The study had 64 females and 8 males in total aged between 19 and 63 years. Mean surgical time in group A (31 females, 5 males) was 48 minutes whereas in Group B (33 females, 3 males) it was 44 minutes. Intra operative haemorrhage was seen in 16% (n= 6) patients of Group A and 11% (n= 4) of Group B. Patency at the end of six months was sustained in 91% (n= 33) patients in Group A and 86% (n= 31) patients in Group B. Conclusion: Both techniques offer viable surgical alternatives as far as correction of naso lacrimal obstruction is concerned. Keywords: Dacryocystitis, External DCR, Endonasal DCR.