Scribd Logo
Upload

Welcome to Scribd!

  • 90 views

    Dacryocystorhinostomy

    Uploaded by

    Narla Susheel
    The document discusses the procedure of dacryocystorhinostomy (DCR) which is performed to treat tearing caused by a blocked nasolacrimal duct. DCR involves surgically creating an opening from the lacrimal sac directly into the nasal cavity to bypass the blockage. The procedure can be performed externally through a small incision or endoscopically through the nose, with endoscopic having less pain and no external scarring. Success rates for relieving tearing with DCR are over 90%.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Dacryocystorhinostomy

    Uploaded by

    Narla Susheel
    90 views3 pages
    The document discusses the procedure of dacryocystorhinostomy (DCR) which is performed to treat tearing caused by a blocked nasolacrimal duct. DCR involves surgically creating an opening from the lacrimal sac directly into the nasal cavity to bypass the blockage. The procedure can be performed externally through a small incision or endoscopically through the nose, with endoscopic having less pain and no external scarring. Success rates for relieving tearing with DCR are over 90%.

    Original Description:

    COSMETIC PROCEDURE

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses the procedure of dacryocystorhinostomy (DCR) which is performed to treat tearing caused by a blocked nasolacrimal duct. DCR involves surgically creating an opening from the lacrimal sac directly into the nasal cavity to bypass the blockage. The procedure can be performed externally through a small incision or endoscopically through the nose, with endoscopic having less pain and no external scarring. Success rates for relieving tearing with DCR are over 90%.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    90 views3 pages

    Dacryocystorhinostomy

    Uploaded by

    Narla Susheel
    The document discusses the procedure of dacryocystorhinostomy (DCR) which is performed to treat tearing caused by a blocked nasolacrimal duct. DCR involves surgically creating an opening from the lacrimal sac directly into the nasal cavity to bypass the blockage. The procedure can be performed externally through a small incision or endoscopically through the nose, with endoscopic having less pain and no external scarring. Success rates for relieving tearing with DCR are over 90%.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    1/23/2017 Dacryocystorhinostomy

    DACRYOCYSTORHINOSTOMY(DCR)
    VijayRamakrishnan,MD
    ToddKingdom,MD

    INTRODUCTION
    Dacryocystorhinostomy(DCR)isaprocedureperformedforthetreatmentoftearing(epiphora)dueto
    blockageofthenasolacrimalduct.Tearsoriginateinthelacrimalgland,locatedattheupperoutermarginof
    theeye.Astearscrosstheeyewitheachblink,theyaredirectedintosmallopeningsintheeyelidscalled
    puncta.Fromthispoint,tearstravelthroughapathwayknownasthecanalicularsystemintothelacrimalsac.
    Thelacrimalsacislocatedbetweentheeyeandthenose,andfunnelstearsintothenasalcavitythroughthe
    nasolacrimalduct(Figure1).Asthisisquitealongpathfortearstotravel,therecanbemanycausesof
    excessivetearing.Blockageofthenasolacrimalductisonecommoncause,andcanbetreatedbycreatinga
    directopeningfromthelacrimalsacintothenasalcavityinaprocedureknownasDCR.Theevaluationand
    managementoftearingmayinvolvebothanophthalmologistandanotolaryngologist.

    Fig1.Tearsoriginatingfromthelacrimalglandcrossovertheeyeintothecanalicularsystemontheirwaytothenasalcavity.

    INDICATIONS
    DCRisindicatedinthetreatmentoftearingduetonasolacrimalductobstruction.Blockageofthisductcan
    beduetotrauma,priorsurgery,tumor,orinflammatorymedicalconditions,butmostcommonlyoccurs
    withoutanidentifiablecause.Todetermineifthisistrulytheproblemareainapatientwithtearing,anumber
    oftestsmaybeperformed.Aphysicalexaminationisperformedbythephysician,andisoftenfollowedby
    probingandirrigationofthecanalicularsystem(Figure2).Placementofdyeinthetearsmaybeobserved
    andtimedforclearance.Thisevaluationiseasilydoneandwelltoleratedintheofficesetting.

    http://care.american-rhinologic.org/dacryocystorhinostomy?print 1/3
    1/23/2017 Dacryocystorhinostomy


    Fig2.Probingandirrigationiscommonlyperformedintheevaluationoftearing.

    PROCEDURE
    Surgeryisoftenperformedundergeneralanesthesia,butmaybeperformedunderlocalanesthesia
    accordingtopatientorsurgeonpreference.DCRcanbeachievedfromanexternal(throughafacialincision)
    approachorfromanendoscopic(usingasmalltelescopeandinstrumentsthroughthenose)approach.The
    goaloftheprocedureistobypasstheobstructednasolacrimalductandallowforteardrainageintothenose
    directlyfromthelacrimalsac.ExternalDCRapproachesthelacrimalsacthroughasmallincisionbetween
    theeyeandthenose.Thelacrimalsacisidentifiedandopenedintothenasalcavity.Tomaintainthe
    opening,thesurgeonmayusesuturesorstents(Figure3).

    Fig3.Ifused,astentisplacedthroughthepunctaintothenose.

    EndoscopicDCRaccomplishesthesamegoal,butisperformedthroughthenosewiththeuseoftelescopes
    andsmallinstruments.ThisapproachtoDCRisnowcommonlyperformedbecauseitavoidsafacialscar,
    andisgenerallyassociatedwithlesspain.Thelocationofthelacrimalsacisknownbasedonextensive
    anatomicstudy.Boneisremovedfromtheareaoverthelacrimalsacandthesacisopenedintothenose
    (Figure4).Somesurgeonsprefertousestentsforsometimepostoperativelytomaintaintheopening.

    http://care.american-rhinologic.org/dacryocystorhinostomy?print 2/3
    1/23/2017 Dacryocystorhinostomy

    Fig4.Intraoperativeendoscopicviewoftheopeningcreatedfromthelacrimalsacintothenose(circled),afterirrigationwith
    fluoresceindye.Thecommoninternalpunctumislocatedattheasterisk.

    RISKS
    Intheendoscopicapproach,painisminimalandcanbecontrolledwithacetaminophenormildprescription
    painmedications.Infectionisuncommon,butmanysurgeonsprefertoadministerantibioticsaftersurgery.
    Bleedingshouldbeminimal,butrarelycanbesignificant.Scarringwithinthenosemayoccur,leadingto
    blockageoftheopeningandrecurrenceoftearing.Althoughextremelyrare,themajorriskoftheprocedure
    isbleedingwithintheorbitalcavity(orbitalhematoma)orinjurytoaneyemuscle,whichmaycausedouble
    visionorvisionloss.Scarandtemporarybruisingwilloccurwithexternalprocedures,althoughtheseshould
    berelativelyminor.Ifyoursurgeonpreferstokeepastentinplaceafterwards,prolapse(movementoutofthe
    noseorupintotheeye)mayoccur,whichrequiresstentadjustmentorremoval.

    BENEFITS
    DCRisafairlysimpleoutpatientprocedure.Overallsuccessratesexceed90%,althoughinparticularcases
    thelikelihoodofsuccessmaybelower.Therisksandsideeffectsoftheprocedurearerelativelylow,andcan
    potentiallyleadtoalonglastingreliefofbothersometearing.

    SUMMARY
    Althoughtherearemanycausesoftearing,somepatientsareexcellentcandidatesforDCR.Aproper
    evaluationmusttakeplacetodeterminethelikelihoodofsuccesswiththissurgery.Asanoutpatient
    procedure,DCRpresentsaniceoptionforpatientswithbothersometearingduetoobstructionofthe
    nasolacrimalduct.Surgeonswillhavetheirownpreferencesinparticularaspectsoftheprocedureexternal
    orendoscopic,useofstents,sizeofopeningcreated,postoperativevisitschedulebuttheultimategoals
    andsuccessratesarequitesimilar.

    Revised01/20/2015
    AmericanRhinologicSociety

    http://care.american-rhinologic.org/dacryocystorhinostomy?print 3/3

    You might also like