[Endoscopic endonasal dacryocystorhinostomy: indications, technique and results]

From 1996 till August 1998 the authors made 24 EDCRS in 23 patients aged 35 to 80 years, incl. 6 men and 17 women. All patients reported epiphora, in 19 cases a mucous purulent secretion from the lacrimal pathways was present and 9 had a history of phlegmon in the area of the lacrimal sac. Irrigation of the lacrimal pathways revealed occlusion which was confirmed also on dacryocystography. The cause of occlusion was in four instances iatrogenic (rhinosurgical operation), in another two post-traumatic and in six there were pathological findings in the nasal cavity. In two instances the authors detected a dacryolith and in 10 idiopathic stenosis was found. The operation was performed under general anaesthesia, using an endoscopic endonasal approach, without permanent or serious complications. On operation in 15 instances postsaccal stenosis was detected, in 7 instances intrasaccal stenosis and in two patients a dacryolith was present. A concurrent mild presaccal stenosis was present in three patients and was treated by insertion of a catheter into the lacrimal pathways for a period of several weeks (except these situations the authors do not indicate its use). After 24 EDCRS epiphora persists only in one patient (with a presaccal component of stenosis), in the remaining patients epiphora is no longer present and irrigation of the lacrimal pathways is free. Minor traumatization without injury of the medial palpebral ligament and normal function of the lacrimal pump are basic advantages of the endonasal approach. The majority of authors report patency of the lacrimal pathways which is achieved by the method of EDCRS in 83-86% of patients. The authors results are similar and justify the recommendation to consider EDCRS as the method of choice in the surgical treatment of intrasaccal and postsaccal stenoses of the lacrimal pathways.