Post operative management and complications

A topical steroid-antibiotic combination should be prescribed and the nose inspected






Lacrimal Endoscope


Lacrimal bone

Maxilla bone

Mucosal edge

Lacrimal bone

Maxilla bone

Mucosal edge

Lacrimal Endoscope



Sac mucosa


Sac mucosa


Figure 16.3 a-16.7b Right endonasal surgical DCR:



Figure 16.3 a-16.7b Right endonasal surgical DCR:

16.3a The light beam is visible in the middle meatus on the lateral nasal wall; 16.3b view of light-pipe transillumination with 30° Hopkins endoscope, S=septum, LR=lacrimal ridge, MT=middle turbinate, E=endoscope.

16.4a A freer elevator is placed close to the lacrimal ridge, in preparation for raising the mucosal flap (visible blood is from local anaesthesia); 16.4b the mucoperiosteal flap is raised with a freer elevator (F).

16.5a Blakesley forceps are used to grasp and excise nasal mucosa; 16.5b the lacrimal bone is removed with Blakeseley forceps (B).

16.6a The lacrimal sac mucosa is opened with an angled keratome; 16.6b an angled keratome (K) is used to open the lacrimal sac.

16.7a Silicon intubation is passed and knotted in the nasal space; 16.7b the intubation is retrieved from the nose using curved artery forceps, ST=Silicone tube, B=bodkin.

Blake Lively Nude
Figure 16.8 Holmium-YAG laser is being used to ablate nasal mucosa, just anterior to the area of transillumination, during left endonasal laser DCR.

in the post operative period. The silicone intubation is typically removed after 6-12 weeks and the function of the anastomosis assessed at about six months.

Complications specific to endonasal surgery may include canalicular damage as a result of the greater instrumentation, collateral laser damage to the mucosa of the nose or lacrimal sac, or the formation of granulation tissue at the rhinostomy or scarring during the healing phase. If the rhinostomy fails due to fibrosis, the anastomosis may be revised either with further endonasal surgery or by external DCR (Chapter 15).

Various success rates have been reported (Tables 16.1 and 16.2), but the perioperative use of a topical anti-metabolite, such as Mitomycin C, appears to reduce the failure rate by decreasing the fibrosis associated with secondary intention healing.

Further reading

Boush GA, Lempke BN, Dortzbach RK. Results of endonasal laser-assisted dacryocystorhinostomy. Ophthalmology 1994; 101:955-9.


Caldwell GW. Two new operations for obstruction of the nasal duct with preservation of the canaliculi, and an incidental description of a new lacrymal probe. Am J Ophthalmol 1993; 10:189-95.

Camera JG, Bennzon AU, Henson RD. The safety and efficacy of mitomycin C in endonasal endoscopic laserassisted dacryocystorhinostomy. Ophthal Plast Reconstr Surg 2000; 16:114-18.

Gonnering RS, Lyon DB, Fisher JC. Endoscopic laser-assisted lacrimal surgery. Am J Ophthalmol 1991; 111:152-7.

Hartikainen J, Grenman R, Puukka P, Seppa H. Prospective randomised comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology 1998; 105:1106-13.

Jokinen K, Karja J. Endonasal dacryocystorhinostomy. Arch Otolaryngol 1974; 100:41-4.

Massaro BM, Gonnering RS, Harris GJ. Endonasal laser dacryocystorhinostomy. A new approach to nasolacrimal duct obstruction. Arch Ophthalmol 1990; 108:1172-6.

McDonough M, Meiring JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol 1989; 103:585-7.

Metson R. The endoscopic approach for revision dacryocystorhinostomy. Laryngoscope 1990; 100:1344-7.

Orcutt JC, Hillel A, Weymuller EA. Endoscopic repair of failed dacryocystorhinostomy. Ophthal Plast Recontr Surg 1990; 6:197-202.

Rouviere P, Vaille G, Garcia C, Teppa H, Freche C, Lerault P. La dacryocysto-rhinostomie par voie endo-nasale. Ann Otolaryngol Chir Cervicofac 1981; 98:49-53.

Sadiq SA, Hugkulstone CE, Jones NSS, Downes RN. Endoscopic holmium:YAG laser dacryocystorhinostomy. Eye 1996; 10:43-6. Sprekelsen MB, Barberan MT. Endoscopic dacryo-cystorhinostomy: surgical technique and results. Laryngoscope 1996; 106:187-9. Steadman MG. Transnasal dacryocystorhinostomy.

Otolaryngol Clin North Am 1985; 18:107-11. Szubin L, Papageorge A, Sacks E. Endonasal laser assisted dacryocystorhinostomy. Am J Rhinol 1999; 13:371-4. Weidenbecher M, Hoseman W, Buhr W. Endoscopic endonasal dacryocystorhinostomy: results in 56 patients. Ann Otol Rhino Laryngol 1994; 103:363-7. West JM. A window resection of the nasal duct in cases of stenosis. Trans Am Ophthalmol Soc 1909-11; 12:654-8. West JM. The intranasal lacrimal sac operation. Its advantages and its results. Arch Ophthalmol 1926; 56:351-6. Whittet HB, Shun-Shin GA, Awdry P. Functional endoscopic transnasal dacryocystorhinostomy. Eye 1993; 7:545-9.

Woog JJ, Metson R, Puliafito CA. Holmium:YAG endonasal laser dacryocystorhinostomy. Am J Ophthalmol 1993; 116:1-10.

Yung MW, Hardman-Lea S. Endoscopic inferior dacryocystorhinostomy. Clin Otolaryngol 1998, 23:152-7. Zilelioglu G, Ugurbas SH, Anadolu Y, Akiner M, Akturk T. Adjunctive use of Mitomycin C on endoscopic lacrimal surgery. Br J Ophthalmol 1998; 82:63-6.

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