DACRYO-CYSTORHINOSTOMY

Principle : A fistula is created between lacrimal sac and middle meatus of nose to bypass the blocked nasolacrimal duct tear drainage.

indication Conventional (external approach) dacryocystorhinostomy (DCR) is indicated for obstruction distal to the medial

opening of the common canaliculus

method

1. The nasal fossa of the same side is packed with cocaine or xylocaine and adrenaline.

2. The canaliculi are dilated and lacrimal sac is irrigated with warm saline.

3. surgery is usually done under hypotensive general anesthesia

4. A vertical incision 10 mm medial to inner canthus is given

5. the medial canthal tendon and lacrimal sac exposed and reflected, and after removal of the intervening bone the sac is incised and attached to an opening created in the nasal mucosa

details:

1. The periosteum over the lacrimal crest is incised and lacrimal bone is exposed. 

2. The bony crest is removed with a gouge and hammer/bone nibbler and nasal mucosa is exposed.

3. The nasal mucosa of the middle meatus is anastomosed with the medial wall of the sac by making

4. vertical incisions in them.

5. Syringing is done to test the patency of the passage after 1-2 days postoperatively.

Complications

i. Haemorrhage—Intranasal bleeding may occur from the nasal mucosa which requires nasal

packing for 24 hours.

ii. Failed DCR—Small bony opening is the most important cause. Other causes include, improper

suturing, postoperative infection, nasal pathology such as polyp, etc.