Clin Exp Otorhinolaryngol.  2009 Sep;2(3):141-144.

The Surgical Outcome of Endoscopic Dacryocystorhinostomy According to the Obstruction Levels of Lacrimal Drainage System

• Choi JC
• Jin HR
• Moon YE
• Kim MS
• Oh JK
• Kim HA
• Choi MY
• Shim WS

Abstract

OBJECTIVES
Many factors influence the outcome of endoscopic dacryocystorhinostomy (DCR). One of the most important prognostic factors is the level of obstruction in the lacrimal drainage system. The main objective of this report is to evaluate both the frequency of obstruction by anatomical region of the lacrimal drainage system on dacryocystography (DCG) and the surgical outcome of endoscopic DCR according to the obstruction level. METHODS: A retrospective series of 48 patients (60 eyes) who had undergone endoscopic DCR from January 2005 to November 2007 were enrolled. Preoperative evaluation consisted of a standard examination which included lacrimal irrigation, probing, DCG and osteomeatal unit (OMU) computed tomography. Patients were classified into four groups according to the obstruction level on DCG. Surgical outcome was evaluated postoperatively by subjective improvement of epiphora and patent rhinostomy opening on nasal endoscopic exam. RESULTS: Of 60 eyes, the levels of obstruction were the common canaliculus in 14 eyes (23.3%), the lacrimal sac in 13 eyes (21.7%), the duct-sac junction in 13 eyes (21.7%) and the nasolacrimal duct (NLD) in 20 eyes (33.3%). The ductsac junction obstruction was treated most successfully (100%), followed by NLD obstruction (90%), common canaliculus obstruction (78.6%) and saccal obstruction (69.2%). CONCLUSION: In patients with lacrimal drainage system obstruction, preoperative evaluation of obstruction level using DCG may be helpful for predicting the surgical outcome of endoscopic DCR. The saccal obstruction may have a worse prognosis than the other obstruction levels.

Keyword

Lacrimal sac; Lacrimal duct obstruction; Epiphora; Dacryocystorhinostomy

MeSH Terms

Dacryocystorhinostomy
Drainage
Eye
Humans
Lacrimal Apparatus Diseases
Lacrimal Duct Obstruction
Nasolacrimal Duct
Prognosis
Retrospective Studies

Figure

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  Fig. 1 Preoperative dacryocystographic findings show various obstruction locations in the left lacrimal drainage system (A) common canaliculus. (B) lacrimal sac. (C) duct-sac junction. (D) nasolacrimal duct.

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  Fig. 2 Operative technique of endoscopic dacryocystorhinostomy. (A) A vertical mucosal incision is made at the lateral nasal wall. (B) Mucosal flap is elevated and resected. (C) The maxillary bone covering the lacrimal sac is removed. (D) The anteriorly based lacrimal sac flap is everted and adjusted to accurately appose the nasal mucosa. Note that the common canalicular opening (indicated with arrow) is visible. (E) The silicone bicanalicular tube is positioned. (F) Nasal endoscopic finding six months after surgery. The rhinostomy opening (arrow) is wide and patent. S: septum; MT: middle turbinate; IT: inferior turbinate; LS: lacrimal sac.

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  Fig. 3 Surgical outcome of endoscopic dacryocystorhinostomy according to the obstruction levels of lacrimal drainage system. It shows that the success rate is highest in duct-sac junction obstruction (100%) and lowest in saccal obstruction (69.2%), but there is no statistically significant difference between the groups (P=0.32) (Fisher's exact test).

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