format for short case presentation,vidio not include

2. Endoscopic Endonasal Management of
Chronic Dacryocystitis
Dr. Md Sayaduzzaman
Dept of ENT & Head-Neck Surgery
Dhaka

3. PARTICULARS OF THE PATIENT
 NAME : X
 AGE : 39 YEARS
 SEX : MALE
 ADDRESS:
• VILL : x
• PO : Y
• PS : F
• DIST : r
 DATE OF ADMISSION : 10.08.17

4.  Recurrent whitish discharge from right eye for
last three and half years
 Right sided nasal obstruction for same duration
CHIEF COMPLAINT

5. According to the statement of the patient he was reasonably well
three and half years back then he developed recurrent whitish
discharge from his right eye. He also complains of nasal
obstruction in the right side for same duration, incidence of cold
attack or spells of nasal obstruction causes increase of
mucopurulent discharge from right eye. He has no history of
having any nasal mass, nasal polyposis, ocular trauma or any sort
of nasal or ocular surgery. He was referred from EYE OPD to
ENT OPD and then he was admitted in ENT ward for needful
management.
HISTORY OF PRESENT ILLNESS

6. HISTORY OF PAST ILLNESS
• No history of DM, HTN, Asthma
PERSONAL HISTORY
• Nothing significant.
FAMILY HISTORY
• Nothing significant.
TREATMENT HISTORY
• H/O repeated reporting to eye OPD and use of
topical eye antibiotic drop in right eye.

7. Appearance : Normal
Body built : Average
Cooperation: : Cooperative
Nutrition : Average
Anaemia
Cyanosis
Jaundice
Dehydration
Oedema
Clubbing
Koilonychia
Leukonychia
Pulse : 82/min, Regular.
BP :130/80mm of Hg
Temperature : 98.4°F
Respiratory Rate : 18/min
Absent
GENERAL PHYSICAL EXAMINATION

8. SYSTEMIC EXAMINATION
Cardiovascular System
Respiratory System
Alimentary System
Nervous System
Genitourinary System
NAD

9. Examination of EYE
• 6/6 both eyesVisual acuity
• Normal both eyesEye lid
• Some eyelashes are matted near
medial canthus of right eyeEye lash
• Mildly oedematous and
congested
Skin over
lacrimal sac

10. SAC PATENCY TEST
Mainstay diagnostic tool

11. Examination of Nose
• Mild oedema of right side of the root
of the nose near the medial canthus
of right eye
External nose
• NormalPosterior Rhinoscopy
• Sense Of Smell:normalFunctional Examination of Nose

12. ANTERIOR RHINOSCOPY
 Nasal mucosa : Mildly edematous
 Septum :
 Floor of nose : NAD
 Lateral wall : NAD
 Turbinate :
Examination of Nose
Opening of nasolacrimal duct express
nothing while pressing over lacrimal sac on
right side
Deviated to right side ,nasal airway is
compromised

13. Nasoendoscopic Examination

14. Examination of Ear :
Examination of Oral cavity and Oropharynx :
Examination of Neck :
NAD

15. SALIENT FEATURE
Sgt Amirul Islam,39 years old, admitted in CMH Dhaka
with the complaints of recurrent purulent discharge from
his right eye for three and half years. He also complains
of nasal obstruction on right side for same duration. On
examination of right eye, nasolacrimal duct was found
obstructed on sac patency test and in nasoendoscopic
examination. Nasal septum was deviated to right side
compromising the airway.

16. CLINICAL DIAGNOSIS
CHRONIC DACRYOCYSTITIS (RT) WITH
DEVIATED NASAL SEPTUM (RT)

17. INVESTIGATIONS
Complete blood count
Hb % : 13.5 gm/dl
ESR : 08 mm in
Total count : 9x109/L
Differential count
Neutrophil : 65%
Eosinophil : 2.2%
Basophil : 00%
Lymphocyte : 20%
Monocyte : 05%
Platelet count : 205x109/L
Bleeding time : 02 / min
Coagulation time : 08 / min
RBS : 5.9 mmol/L
Blood group : B (+ve)
Urine R/E : NAD
Serum urea : 27 mg/dl
Serum creatinine : 0.7 mg/dl
ECG : NAD
Chest x-ray : Normal

18. X-ray PNS OM view : Deviated nasal septum right side

19. TREATMENT
SEPTOPLASTY & ENDONASAL ENDOSCOPIC DCR WITH
SILICON TUBE INSERTION UNDER GENERAL
ANESTHESIA ON 10/09/2017

20. OPERATIVE PROCEDURE

21. POST OPERATIVE CARE
 Merocel nasal pack was removed on following morning and patient
was advised to irrigate nose with saline twice a day.
 Patient visited one week later
 The silastic DCR tube was removed six weeks after surgery
 Patient was advised to report 3 monthly for 1 year .

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2016 2017 2018
2016
2017
2018
STATISTICS OF ENDOSCOPIC DCR

23. Endoscopic DCR,is a minimal invasive procedure and
has comparable good result with conventional external
DCR.This operation is now considered safe alternative
when it comes with associated nasal pathology.
Endoscopic DCR may be indicated on a primary basis
or as revision surgery following external DCR. Under
endoscopic guidance nasal anatomy is understood
better, managed accordingly, sac is approached under
direct vision so operation outcome is better &
complication rate is less in endoscopic DCR.
CONCLUSION