External Transconjunctival Dacryocystorhinostomy: Success without disfiguring scar

Abstract

 

Purpose

 

External transcutaneous dacryocystorhinostomy (DCR) remains the eternal gold standard in the treatment of nasolacrimal duct obstruction (NLDO) with >95% success. However, a cosmetic blemish from a scar after transcutaneous DCR is a reason for preference of an endonasal DCR. External transconjunctival DCR is a novel technique which has comparable success without a visible scar. In the only previous study describing the technique, the authors converted to transcutaneous DCR in 34% owing to intraoperative difficulties. We describe a modified technique of transconjunctival DCR that was initially performed on cadavers followed by human subjects. We performed this study to evaluate the feasibility and outcome of external transconjunctival DCR in primary acquired NLDO in adults.

 

Methods

 

Retrospective analysis of all patients after transconjunctival DCR between January and June 2013 was done. Outcome measures included anatomical patency and epiphora at final follow-up and presence of a visible facial scar at the nasal bridge 1 month after surgery.

 

Results

 

Transconjunctival DCR was performed in 10 patients. Mean age was 46.8 +/- 12.8 years with an equal gender distribution. Mean duration of epiphora was 33.5 months and 9 patients had regurgitation of purulent material on pressure over sac. Surgery could be performed successfully in 8/10 (80%) patients. Transconjunctival was converted to transcutaneous DCR and dacryocystectomy in 1 patient each because of poor exposure and fibrosed lacrimal sac respectively. Anatomical patency and relief from epiphora was achieved in 9/10 (90%) patients. All patients (100%) who underwent transconjunctival DCR were anatomically patent on syringing and had no epiphora at median follow-up of 3.5 (range 1-6) months. Absence of a visible facial scar at the nasal bridge was achieved in all (100%) patients at one month.

 

Conclusions

 

Modified transconjunctival DCR holds promise as an alternative technique in the treatment of NLDO. Absence of a visible facial scar, excellent success rate without the need for endoscope/LASER are significant advantages.

 

 

1 Inferior forniceal incision in A. 45 year male showing probe (arrow) in sac and B. Cadaveric right eye showing metal instrument (arrowhead) in nose.

 

 

2A. Photograph of the face of a 45-year-male shows no visible scar at nasal bridge at 1 month. B. Slit lamp photograph under diffuse illumination shows linear conjunctival scar at the incision site.

 

Keywords: 465 clinical (human) or epidemiologic studies: systems/equipment/techniques • 526 eyelid