Nasal endoscopic assessment of failure after external dacryocystorhinostomy.

PURPOSE: To study intranasal causes of failure of external dacryocystorhinostomy (DCR).

DESIGN

A retrospective study of clinical data from transnasal endoscopic findings after failure of external DCR.

METHODS

Assessment of 65 patients with failure after external dacryocystorhinostomy; subjectively by patient's symptoms and saccharine test and objectively by patency on syringing, functional endoscopic dye test and endonasal endoscopic assessment.

RESULTS

Endoscopic findings revealed: 20 cases intranasal adhesions, 8 cases septal deviation and concha bullosa, 8 cases abnormal size fistula, 6 cases rhinosinusitis, 6 cases contact granuloma, 3 cases of pouch, 4 cases closed ostium, 10 cases no definite cause could be found (functional failure). Negative dye clearance test and non-detection of fluorescein on irrigatiom in 55 patients. Delayed dye clearance but detection of fluorescein on irrigation in 10 patients (functional failure).

CONCLUSIONS

Nasal endoscopy is very important in diagnosing causes of failure of external DCR. Nasal endoscopy is essential before and after external DCR. DCR should be done by a team work of rhinologist and ophthalmologist. Study of mucociliary clearance of lacrimal pathway will help to improve our surgeries and whether to do small or large fenestra technique.