DCR and CDCR

1.  By
Dr.Muhammad Sherwani
M.B.Ch.B,F.I.C.M.S
Rizgary Teaching Hospital-Erbil

2. Knowledge
is
Power

3. Tearing to some happiness
Tearing to others sadness
While to ENT surgeon surgery

4.  Epiphora:
Tearing due to
blockage of the
lacrimal passage
(usually need surgery)
 Lacrimation:
It’s reflex tearing, or
hyperlacrimation due
to irritation of cornea
or conjunctiva.
(ophthalmologic
medically treated)

5.  Late 1980 as ESS
became popular
 Now the EDCR with
best hands 90-95%
 In early 20th Toti
descriobe the Ext -
DCR
 Best Oculoplastic
hands 80-85%

6.  Endoscopic –DCR
1. Higher success rate
2. No scar
3. Shorter time
4. Less pain
5. Less bleeding
 EXT-DCR
1. Lower success rate
2. Scar
3. Longer operation
4. More pain and
recovery
5. More bleeding

8. Cooperation time

9.  First visit of patient
 Diagnosis and
differentiation
 Referral to
ENT surgeon

ophthalmologist
ophthalmologist

11.  Puncta
 Canaliculus
 Common canaliculi
 Lacrimal sac
 Lacrimal duct

12. 1. Physical factors
2. Patent pathway
3. active lacrimal
pump
4. Distention of LS
5. Absorption of
tear

13.  Punctal stenosis/obstruction
 Canalicular stenosis/obstruction
 Obstruction in Sac (stone,diverticuli,tumor)
 Nasolacrimal blockage (PANDO) usually
unknown origin of non traumatic form
 Functional Epiphora (patent pathway with
epiphora)
 Nasal diseases ,rare cause
 surgery or trauma

14.  Excessive tearing
(rundown on check,
windy,cold weather)
 Matting of eyelashes
 Mucus of pus like
discharge in puncta
 infection dacyrocyistits,
even fistula

15.  Tearing epiphora
lacrimation
 Epiphora anatomical
physiological (patent pathway
with failure drainage)
 Anatomical presaccular
saccular
postsaccular
 Define the surgical approach

16.  Made by
 ENT: participate in nasal examination to
exclude other causes

17.  Anatomical test:
1. Ophth.inspection
2. Nasal examination
3. Diagnostic probing
4. Syringing(irrigation)
5. DCG
6. CT and MRI
 Physiological test:
1. Fluorescein dye
2. Scintigraphy
3. Jones dye
4. Saccharin test
 Test of secretion:
1. Schirmer’s test
2. Bengal rose test
3. Tear film break up
4. Tear lysozyme

18. Done for all Tearing Sufficient for Diagnosis
 Ophthalmologic
Examination
 Nasal examination
 Fluorescein dye
disappearance test
 Diagnostic
probing
 Irrigation of NLD
 Function
 Location
 Degree of
anatomical
blockage

21. A. Hard stop
B. Soft stop

22.  If it’s anatomical
,hard stop, distal part
of Nasolacrimal
system
DCR
 If it’s anatomical
,soft stop, proximal
part of Nasolacrimal
system
CDCR with Lester
Jones tube

28. Crawford silicon tube and
stent

31. CDCR
(conjuctivodacryocystorhinostomy)

38. • 30% of full term present with imperforated
valve of hasner.
• Most undergo spontaneous opening by age
9months
• 10% need probing by age 6-13months
• DCR indicated at age 2 years or older
• CDCR indicated at age 12 years or older

39. Thank you
‫سوثاس‬