how to get 100% success in endoscopic dcr by beginners

1. Dr Zeeshan Ahmad
M.S.(ENT, PGY3)
Department of ENT, NMCH, Patna.29.01.2015

2.  DCR
 Opthalmologist -----------> Otolaryngologist
 Big responsibility for ENT to give ~100% result
 For 100% result – proper case selection

3. These features ensure success :-
 Epiphora duration <1 year
 No history of pus or abscess
 Prefer female patient
 Able to do nasal douching
 Can come for follow up regularly
 No Opthalmic comorbidities

4. These features ensure success :-
 Regurgitation test positive
 Hard stop on probing
 Distended sac
 Syringing yields mucoid material slowly
 DNS to the opposite side

5. Can do all the cases
But caution is required in following :-
 Gross DNS to Operative side
 Revision case
 Case with suppuration
 Common canalicular block

6.  Steroid - if too inflamed
 Regular preop syringing
 Antibiotics oral/topical
 Control nasal allergy

7.  Bone removal – bone removal – bone removal
 Expose upto - sac fundus
 Incise after tenting with lacrimal probe
 Fashion the sac like a book
 Tuck the sac beneath nasal mucosa
 Achieve hemostasis without packing
 Use stent in revision cases

8.  DCR has moved from the hands of
opthalmologists to the Otolaryngologist
 not just because it has scar advantage
 but it is also more physiological and
 epistaxis is better controlled.
 Our series - 14 cases – 2 failures
one due to CC block and other due to
inefficient bone removal.

10. 05.02.15 Dr Sonu Kr Singh
M.S.(ENT,PGY3)
Juvenile Nasopharyngeal
Angiofibroma – origin,
spread, management