Laserassisted and endonasal lacrimal surgery

Jane M Olver

Endonasal dacryocystorhinostomy is performed entirely within the nose, either by direct visualisation or by using a rigid Hopkins endoscope as the light source and to magnify the structures on the lateral nasal wall. Surgical instruments or laser (or a combination) are used to create an anastomosis between the lacrimal sac and the nasal space (Figure 16.1).

It differs from external DCR (Chapter 15) in that there is no external incision, there are no sutured mucosal flaps and there is usually temporary silicone intubation.

Caldwell, in 1893, first described the use of an electric drill to open the lacrimal sac and nasolacrimal duct into the nasal space from an intranasal approach and West subsequently described another endonasal approach, a so-called "window resection of the nasolacrimal duct". Recognising that the sac-duct junction appeared to be the commonest site of lacrimal outflow obstruction, West later

Site of endonasal

Site of endonasal

Figure 16.1 Right lacrimal system, with the site of the anastomosis outlined.

extended the resection to include the lacrimal sac and this remains the principle of modern endonasal lacrimal drainage surgery. Between 1950 and 1990 most lacrimal surgery was performed using an external approach by ophthalmologists, with only few otolaryngologists continuing to practise endonasal surgery. The increased usage of rigid nasal endoscopy and laser surgery has, however, helped to popularise modern endonasal dacryocystorhinostomy, with the results of endonasal endoscopic DCR ranging from 63-99% (Tables 16.1-16.2).

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