Conjunctivodacryocystorhinostomy: Indications, Techniques, and Complications

Abstract

Complete proximal bicanalicular obstructions remain one of the most intriguing lacrimal disorders posing a dilemma on both diagnostic and management fronts. Conjunctivodacryocystorhinostomy or CDCR was initially described by Von Hoffman in 1904 [1] and, later, with Jones tubes by Lester Jones in 1962 [2, 3]. In this procedure, a new passage is created for drainage of tears from the conjunctival cul-de-sac directly into the nasal cavity. The procedure can be performed via an external approach (external CDCR), an endoscopic approach (endoscopic CDCR), a minimally invasive approach (MICDCR), or an endoscopic conjunctivorhinostomy (CR) without a DCR. Though the procedure is useful with a success rate hovering around 90 %, large series have shown two major complications, namely extrusion of the tube ranging from 28 % to as high as 51 % and tube malpositions ranging from 22 to 28 % [4–7]. In order to avoid these complications numerous modifications of the bypass tube have been published including additional flanges, wide medial ends, angulated tubes, and porous polyethylene-coated tubes [8–11]. The complications though reduced still continue to be a matter of concern. Minimally invasive placement of Jones tubes without a DCR with and without the use of endoscopic guidance is gaining popularity in recent times [12–14]. Although most of the contraindications to CDCR are relative, careful patient selection is of utmost importance. The chapter will discuss indications, contraindications, techniques, complications, and outcomes of various approaches for CDCR.