Dr. Zeeshan Ahmad discusses considerations for successful dacryocystorhinostomy (DCR) surgery. Certain patient characteristics and test results help ensure success, such as epiphora duration under 1 year, positive regurgitation test, and distended sac on probing. Thorough bone removal from the lacrimal sac is emphasized. Post-operative care involves antibiotics, syringing, and controlling nasal allergy. The document outlines techniques for incising the sac, tucking it under the nasal mucosa, and achieving hemostasis without packing. It notes that DCR has become more of an ENT procedure due to scar advantage and better epistaxis control. The author's series showed a success rate of

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