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Charles Kim, Ashutosh Kacker, Aaron Pearlman, Gary Lelli; Results of Combined Multispecialty Endoscopic Dacryocystorhinostomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):742.
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Endoscopic dacryocystorhinostomy (eDCR) is a procedure commonly performed in the treatment of patients with nasolacrimal duct obstruction (NLDO). Benefits over the external approach include avoidance of cutaneous scarring, less intraoperative bleeding, and a shorter postoperative recovery course. While many oculoplastic surgeons perform the procedure independently, eDCR is commonly carried out in conjunction with otolaryngologists. This allows otolaryngologists to concurrently assess and treat intranasal pathology, while also minimizing complications related to the technical aspects of endoscopy. In this study, we aim to characterize the pre- and post-operative findings in patients undergoing eDCR performed in tandem by oculoplastic surgeons and otolaryngologists.
Retrospective case series consisting of all patients who underwent eDCR performed jointly by the Ophthalmology and Otolaryngology services at New York Presbyterian Hospital/Weill Cornell Medical College between the 2009-2012 academic years. These patients were followed post-operatively for at least six months. Primary endpoints assessed in this study included recurrent symptoms (epiphora) and infection (dacryocystitis).
A total of 20 patients underwent eDCR for NLDO within the study interval. Five of these patients exhibited bilateral NLDO. Of the 25 total cases, 7 (28.0%) represented reoperations due to recurrent symptoms. All 20 patients in the study exhibited sinus pathology, as determined during a pre-operative otolaryngology assessment. As a result, 16 (80.0%) of these patients underwent concurrent sinus surgery at the time of eDCR. In all, 16.7% (3/18) of cases without prior DCR experienced recurrent symptoms, with average time to recurrence of 5.6 months. On the other hand, 42.9% (3/7) of revision cases experienced epiphora post-operatively. One patient in the study experienced post-operative dacryocystitis, which was successfully treated with a short course of amoxicillin/clavulanate. Interestingly, one patient underwent revision DCR for refractory symptoms stemming from allergic fungal sinusitis.
Endoscopic DCR has emerged as a safe and effective method of treating patients with NLDO. While performing this procedure with an otolaryngologist did not appear to significantly improve efficacy, it did offer the advantage of concurrently treating intranasal pathology, which was found in all patients in our series.
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