Dacryocystorhinostomy is a procedure that is performed to allow drainage of tears from the lacrimal sac directly into the nasal cavity. Endonasal telescopes facilitate performance of this operation with better visualization and decreased morbidity. We present our experience with endoscopic laser-assisted DCR. In the last 31 months, we have performed 31 procedures on 23 patients with either the holmium:YAG laser or the argon:HGM laser. We have a 97% overall success rate with a mean follow-up of 16 months. Our series includes both adult and pediatric patients as well as five revision procedures after failed external DCR. We present our technique, results, and the reasons for our change in laser delivery systems. Most importantly, we discuss the technical factors that contribute to our overall success. These include a large rhinostomy size, simultaneous correction of intranasal and/or sinus pathology, the avoidance of laser use within the lacrimal sac, and close postoperative monitoring with intranasal debridement. We conclude that endoscopic laser-assisted DCR is a better alternative to standard external DCR because it avoids a cutaneous scar, excessive tissue injury, and postoperative morbidity.
Over a 1-year period, a cystic bluish coloration developed in the most medial aspect at the margin of the right upper eyelid of a 40-year-old man. The clinical diagnoses were either a conjunctival inclusion cyst or an adnexal cyst, possibly of the gland of Moll. The excised specimen was studied histopathologically and exhibited a lining that was virtually indistinguishable from that of the normal canaliculus, except for hyperplasia of the cellular wall and the focal presence of a superficial mucin-producing columnar cell monolayer at the lumen. The medial edge of the excised specimen showed a merging of the cyst into a nonectatic portion of the canaliculus. Inflammation in the wall of the cyst and in this terminal portion of the canaliculus was not identified. This is believed to be a unique entity of an idiopathic ectasia with mild epithelial proliferation of a segment of the canaliculus. The authors have termed this condition canaliculops, to draw a parallel between it and ectasia of the ducts of the lacrimal gland, so-called dacryops.
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