Endoscopic surgery on the lacrimal apparatus

Abstract

Dacryocystorhinostomy (DCR) is indicated in distal outflow obstruction of the lacrimal system. The fluorescein dye retention test and lacrimal irrigation and probing are used to detect the presence and site of obstruction. Dacryocystography is used to determine the site of stenosis or obstruction. Computed tomography can be used to define the diameter of the bony lacrimal canal, and identifies concurrent nasal or paranasal disease. Lacrimal scintillography is a more functional assessment. Endoscopic DCR can easily be performed by an otolaryngologist who is experienced in endonasal endoscopic surgery. New endoscopic techniques have been developed involving wide bony removal and creation of epithelium-lined mucosal anastomosis, resulting in improved surgical results. Postoperative care consists of topical steroid and antibiotic eye drops, nasal douching with saline, nasendoscopic removal of crusting and blood clots, and removal of silicone tubes. © 2009 Springer Berlin Heidelberg.