Mechanical endonasal dacryocystorhinostomy - A reproducible technique

Abstract

Background: A study to assess the efficacy and patient acceptability of Mechanical Endonasal Dacryocystorhinostomy (MENDCR) in patients with acquired nasolacrimal duct obstruction. Methods: A retrospective series of 38 patients undergoing 37 primary and 7 revision MENDCR's between March 2003 and October 2007. Patients included had symptomatic epiphora with anatomical obstruction on syringing or functional obstruction on scintillography. Short-term follow up was assessed subjectively and objectively by anatomical patency on nasendoscopy and free flow of fluorescein from eye to nose. Medium term follow up was assessed subjectively by telephone conversation with the patient. The average follow up period was 25.2 months (range 7-50). Results: There were 44 DCR's performed on 38 patients (12 male, 26 female). Average patient age was 67.0 years (range 16.6-97.5). Almost all patients (95%) presented with epiphora, and a further 34% with dacryocystitis and/or mucocele. At short term follow up 40/44 (91%) were successful objectively. Of two that failed, neither had a patent ostium and one had recurrent mucocele. Both went on to revision surgery, which was successful at later review. A further two had visible ostia but no free flow of fluorescein. At long term follow up 90% were happy with the procedure and would undergo surgery again. All failures occurred by 3-month follow up. Conclusion: The technique of MENDCR is a reproducible technique with results comparable to the original authors. MENDCR is an acceptable alternative to external DCR. It is well tolerated by patients most of whom were satisfied and would undergo the same procedure again.