J Korean Ophthalmol Soc.  2008 May;49(5):713-720. 10.3341/jkos.2008.49.5.713.

Clinical Outcome of Dacryocystorhinostomy with Septal Deviation

• Lee YJ
• Moon SW
• Cho HY
• Jeong JH

• KMID: 2211699
• DOI: http://doi.org/10.3341/jkos.2008.49.5.713

Abstract

PURPOSE: Septal deviation has few subjective symptoms. However, a difficulty remains in doing DCR (dacryocystorhinostomy) in these patients. We investigate the clinical course of DCR in patients with a septal deviation.
METHODS
Acquired nasolacrimal duct-obstructed patients who had undergone DCR with septal deviation from 2003 to 2006 in our hospital were retrospectively analyzed. We measured the septal distance using paranasal computed tomography taken preoperatively and compared the sex and age of patients, the kinds of operations, outcome of surgery, and ocular and nasal complications in our analysis.
RESULTS
Twenty-two eyes of 22 patients with a mean age of 55.3 years (range 29~74) were analyzed (4 males, 18 females). Mean septal distance was 4.84 mm (range 2.18~6.99 mm). Nineteen eyes had endonasal DCR, and three had external DCR. Two had DCR combined with septoplasty. Three had septoplasty as a secondary operation, Nasal complication was synechiae in 9 eyes. DCR success was seen in 15 eyes, and DCR failure in 7 eyes. Septal distance was not correlated with DCR success but was correlated with nasal complication (Mann-Whitney test, p=0.003)
CONCLUSIONS
In the case of DCR with septal deviation, the surgical technique used will need to minimize the mucosal injury and ensure appropriate nasal correction to prevent future complications.

Keyword

Dacryocystorhinostomy; Nasolacrimal duct obstruction; Septal deviation

MeSH Terms

Dacryocystorhinostomy
Dietary Sucrose
Eye
Humans
Male
Retrospective Studies
Dietary Sucrose

Figure

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  Figure 1. (A) the coronary image in paranasal computed tomography shows the shortest distance (2.14 mm) between inner surface of lacrimal fossa and outer surface of nasal septum. (B) the magnified image of the nasal space in A). (C) the axial image of a septal deviation patient shows the shortest nasal distance (2.4 mm). (D) the magnified image of the nasal space of C.

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  Figure 2. Endoscopic view of the nasal cavity after dacryocystorhinostomy in septal deviation patients without mucous decongestion. (A) there is narrow nasal space. (B) in another patient there is too closed space to see the inner structure. (C) there is severe synechiae between the lateral nasal wall and septal deviation.

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  Figure 3. Adhesion between the lateral nasal wall and nasal septum was observed (A). After synechiolysis was performed, there was shown nasal ostium and tube behind the synechiae (B) which had good function. A diagram of synechiae (C) and after synechiolysis (D).

Reference

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