Endoscopic and external dacryocystorhinostomy: A therapeutic proposal for distal acquired lacrimal obstructions

Abstract

Endoscopic (END-DCR) and external dacryocystorhinostomies (EXT-DCR) are nowadays considered the gold standard techniques for non-oncologic distal acquired lacrimal disorders (DALO). However, no unanimous consensus has been achieved on which of these surgeries is the most suitable to the individual patient. Herein, we review the available literature of the last 30 years with the aim of defining a simple and reproduceable treatment algorithm to treat DALO. A search of PubMed, EMBASE, Scopus and Cochrane databases was last performed in December 2021 to examine evidence regarding the role of END-DCR and EXT-DCR in primary and revision surgeries. If considered primary surgeries, END-DCR should be preferred in case of intranasal comorbidities, given the possibility to directly visualize and treat potential intranasal pathologies. Conversely, EXT-DCR should be chosen in case of need/preference for local anesthesia, given the major historical experience and wider surgical field that helps to resolve intra-operatory complications (e.g., bleeding) in an uncollaborative patient. In the absence of the abovementioned conditions, the decision of one or other approach should be discussed with the patient. In recurrent cases, END-DCR should be considered the treatment of choice given the major likelihood to visualize the causes of primary failure and directly resolve it. In conclusion, END-DCR should be considered the treatment of choice in revision cases or in primary ones associated with intranasal pathologies, whereas EXT-DCR should be chosen if local anesthesia is needed. In the absence of these scenarios, it is still open to debate which of these two approaches should be used.

Efficacy of adjuvant mitomycin-C and triamcinolone-impregnated nasal packing for endoscopic dacryocystorhinostomy

“…No patients developed infections after surgery (Table 4). DISCUSSION Numerous techniques have been documented to forestall the cicatricial closure of the ostium, encompassing measures like sufficiently sized osteotomies [3] , uncinectomy [10] , suturing the lacrimal sac to nasal mucosa [11] , employing mitomycin C as an adjunct [5] , silicone tube intubation [12][13] , utilizing synthetic polyurethane foam as nasal packing [9,14] , lacrimal irrigation in the postoperative period [15] , and the application of media such as sodium hyaluronate to diminish the formation of postoperative granulomas [16] . Among these approaches, the supplementary use of mitomycin C is widely acknowledged and favored for its effectiveness in preventing cicatrix formation at the osteotomy site during the wound healing process [17] .…”

Analysis of the safety and effectiveness of endoscopic nasal dacryocystorhinostomy in the remedy of chronic dacryocystitis

“…Although both methods are standard techniques for DALO treatment, the choice should be individualized based on the specific circumstances and preferences of the patient. [31,32] Table 2 Tear gland secretion function and tear film stability of the 2 groups (x̅ ± s).…”

“…Although both methods are standard techniques for DALO treatment, the choice should be individualized based on the specific circumstances and preferences of the patient. [31,32]…”

The efficacy of endoscopic dacryocystorhinostomy in the treatment of dacryocystitis: A systematic review and meta-analysis

“…But it also has the disadvantages of high operating difficulty, unstable success rate, and high equipment costs. [ 9 , 10 ] Currently, the comparison of the efficacy and safety of EX-DCR and EDCR for the treatment of dacryocystitis is still controversial, and the results of different clinical trials are inconsistent. In order to solve this issue, this paper conducted a meta-analysis of the efficacy of EDCR versus EX-DCR for the treatment of dacryocystitis.…”