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Endoscopic repair of failed dacryocystorhinostomy
J C Orcutt1, A Hillel, E A Weymuller
1Department of Ophthalmology and Otolaryngology, University of Washington, Seattle 98195.
Ophthalmic Plastic and Reconstructive Surgery
|January 1, 1990
Summary
Endoscopic repair effectively treats persistent tearing (epiphora) caused by scarring after dacryocystorhinostomy (DCR) or sinus surgery. This minimally invasive procedure reopens blocked tear ducts, offering relief for most patients.
Area of Science:
- Ophthalmology
- Otolaryngology
- Surgical Innovation
Background:
- Primary dacryocystorhinostomy (DCR) failure often results from scarring at the rhinostomy site.
- Nasolacrimal duct obstruction can occur post-maxillary sinus surgery due to lacrimal bone removal and subsequent scarring.
- Persistent epiphora significantly impacts patient quality of life.
Purpose of the Study:
- To evaluate the efficacy of endoscopic reconstruction for the lacrimal drainage system in patients with DCR failure.
- To assess the outcomes of endoscopic repair in patients experiencing epiphora after maxillary sinus surgery involving lacrimal bone removal.
Main Methods:
- Eight patients (5 post-DCR, 3 post-sinus surgery) with constant epiphora underwent endoscopic lacrimal drainage system reconstruction.
- Preoperative assessment included CT scan or dacryocystography to confirm bony ostium patency.
- The procedure involved endoscopic visualization, resection of scar tissue, reopening of the lacrimal drainage pathway, and silastic stent intubation.
Main Results:
- Seven out of eight patients experienced complete relief of epiphora following stent removal.
- Follow-up ranged from 3 to 24 months post-stent removal.
- The endoscopic approach allowed for simultaneous evaluation and correction of intranasal pathology.
Conclusions:
- Endoscopic repair is a valuable treatment for epiphora resulting from DCR failure or post-sinus surgery complications.
- The procedure is minimally invasive, can be performed under local anesthesia, and avoids skin incisions.
- This technique offers a successful solution for recalcitrant nasolacrimal duct obstruction due to scarring.