Endoscopic Dacryocystorhinostomy in Post-Traumatic Nasolacrimal Duct Obstruction

Abstract

Trauma to the lacrimal sac and nasolacrimal duct (NLD) occurs as a result of mechanical injury and is often associated with facial trauma in 7--15% of cases [1, 2, 3]. It is also encountered during various endoscopic surgical procedures. Management of traumatic NLD obstruction is challenging unlike primarily acquired NLD obstruction as the anatomy of the bony lacrimal fossa and NLD is altered with lot of scarring and the surgery carries an increased risk of failure [2]. Some of the studies prefer external DCR and discourage endoscopic, endonasal or laser DCR in posttraumatic NLD obstruction due to the loss of bony anatomical landmarks after trauma and subsequent surgery [2]. However, in our experience, endoscopic DCR after a comprehensive preoperative evaluation including nasal endoscopy and CT DCG followed by safe and effective drilling in the superior part under direct endoscopic visualization leads to excellent results.