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M. Manning, Jr., J.B. Dickson; Medical Lubricating Jelly for Lacrimal Sac Localization in Endonasal Dacryocystorhinostomy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1963.
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Endonasal dacryocystorhinostomy (DCR) is an effective procedure for the treatment of epiphora caused by nasolacrimal duct obstruction. Advantages of the endonasal approach over direct DCR include lack of cutaneous incision, avoidance of disruption of the medial canthal ligaments with resultant lacrimal pump dysfunction, and excellent visualization of intranasal pathology, which is often the cause of DCR failure. The first important step in endonasal DCR involves localization of the lacrimal sac. Failure to accurately expose the lacrimal fossa for osteotomy placement can cause formation of lacrimal sump syndrome and DCR failure. Some authors have utilized placement of a retinal light pipe, a Bowman lacrimal probe, or instillation of 2% fluorescein with an ophthalmic viscoelastic substance such as Viscoat® for identification of the lacrimal sac. Disadvantages inherent in these techniques include possible lacrimal system trauma with introduction of instrumentation and the expense associated with viscoelastic use. The purpose of this series is to report on the use of medical lubricating jelly instillation as a new, cost effective technique to optimize endonasal DCR.
In this retrospective study, the authors reviewed 12 patients with symptoms of epiphora who subsequently underwent standard endoscopic endonasal DCR with the addition of the following step during the procedure: Approximately 0.5mL of medical lubricating jelly was irrigated through the canaliculus into the lacrimal sac for identification. Following site localization, the nasal mucosa was incised anterior to the middle turbinate and the endonasal DCR was completed in an otherwise standard fashion.
Among the 12 eyes reviewed, all showed symptomatic improvement or resolution of epiphora. All 12 eyes were classified as having normal tear meniscus levels. Thus, all patients evaluated were presumed to have sustained patency and therefore surgically successful treatment. There were no complications such as delayed wound healing, abnormal nasal bleeding, or infection.
Medical lubricating jelly is a clear, water–soluble, nontoxic, and inexpensive substance that can closely simulate the use of an ophthalmic viscoelastic substance. In this series of patients, the use of medical lubricating jelly is an effective adjunct in achieving localization of the lacrimal sac during endonasal DCR. No complications resulted from its use. Through improved visualization during endonasal DCR, surgical outcomes may be improved. Further investigation is warranted.
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