A comparative study of external dacryocystorhinostomy versus endoscopic endonasal dacryocystorhinostomy without stenting

Abstract

Introduction: Dacryocystitis is a condition in which there is inflammation of the lacrimal sac due to stagnation of the sac contents, as a result of stricture of the nasolacrimal duct arising from chronic inflammation, usually of nasal origin (which is much more common) or due to congenital blockage in the nasolacrimal duct.Materials and methods: Retrospective, comparative, randomized interventional study was conducted in the Department of Ophthalmology, Maheshwara Medical College and hospital, Chitkul (V), Near Isnapur X Roads, Patancheru(M), Sangareddy Dist, Telangana, India collaboration with Department of ENT from January 2020 to December 2020. The patients attending the Tertiary care centre fulfilling the inclusion and exclusion criteria were taken up as case. Results: In group A patients, tearing of the anterior nasal flap was seen in 2 cases, and punctum laceration in 1case. In group B patients, 1 cases had bleeding, 3 cases had Trauma to the middle turbinate, while accidental entry into anterior ethmoidal cells was in 4 cases. In 6 cases, there was difficulty in making a bone window. In group A patients, the duration of surgery is comparatively more than in Group B. In the postoperative period, group A patients had epistaxis, rhinostomy site closure, hypertrophied external scar, and medial canthi damage as its complication, while group B epistaxis, nasal Synechea, intranasal granulation at the ostium are major complication. After a period of 3months by syringing the lacrimal sac of the patients in Group A patients, 18 patients had a patent sac (success rate is 90%). In group B patients, 16 patients had a patent sac (success rate being 80%).Conclusion: DCR, either by external or endonasal route, can be considered for treatment of nasolacrimal duct obstruction. The external route has an easy and short learning curve with reduced cost of equipment. Whereas endoscopic DCR is time-saving, avoids a facial scar and injury to the neighboring structures like the medial palpebral ligament and the angular facial vessels. In our study, the success rates of Endonasal DCR and External DCR are almost equal and comparable. This indicates that these two different DCR techniques are acceptable alternatives. However, it's the preference of the patient, the resource available, and the surgeon himself to decide the right surgical option to axe the disease.