Endoscopic V/s External Approach DCR: A comparative Analysis

To compare the surgical procedures, intra-operative & post operative complications and overall success rate of Endoscopic Dacrocystorhinostomy (Endo-DCR) with External approach Dacrocystorhinostomy (DCR).

In this randomized, interventional, comparative study, 50 cases of mechanical Endonasal Dacrocystorhinostomy & 30 cases of conventional External Dacrocystorhinostomy were performed from January 2006 to April 2007 in the department of Ophthalmology in conjunction with department of Otorhinolaryngology, Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh. All patients underwent detailed general, medical and ocular history as well as thorough ocular and ENT examination to rule out any nasal pathology. Level of blockage was diagnosed by lacrimal syringing & probing, Jones dye test and dacrocystography. Surgery was done under local anesthesia except in children and uncooperative patients where general anesthesia was used. For Endo-DCR surgery, 0 & 30 degree rigid endoscope was used. In selected cases silastic sheet were used. The surgical outcomes and complications were analyzed.

Functional success and symptomatic relief were equivalent in both procedures. Endo-DCR surgery was found to be quicker to perform than external DCR surgery. The follow-up duration was comparable in both groups. Patient satisfaction was significantly higher in the Endo-DCR group.

Endo-DCR surgery offers a very attractive alternative to the well established technique of external DCR surgery for the treatment of primary acquired nasolacrimal duct obstruction with equivalent success rates, shorter surgical time and higher patient satisfaction.