Powered endonasal dacryocystorhinostomy: technique and results of a series of patients.

INTRODUCTION External dacryocystorhinostomy (DCR) has been the gold standard for treatment of epiphora. Currently several endoscopic DCR techniques are described. We evaluated results of endonasal DCR in our institution. METHODS A retrospective chart review of a consecutive series of DCR procedures. Patients were subjected to a questionnaire a minimum of 6 months postoperatively to assess longer-term results. RESULTS 19 DCR procedures in 16 patients (6 males) by a single surgeon (LD) were reviewed. Mean age was 60 (range 32 - 79). All patients suffered from epiphora (4-60 months), 7 had recurrent dacryocystitis. The technique involved the creation of a large rhinostomy using a microdebrider with a rough diamond burr and apposition of nasal mucosal and lacrimal sac flaps with Gelfoam. A silicone tube was placed in the nasolacrimal system. Patients were discharged day 1 and all patients reported immediate improvement of symptoms. Postoperative complications were limited to epistaxis in one patient. Patients were seen at week 1, 3 and 6 at clinic to perform suction cleaning until complete internal healing. The silicone tube was removed (at the last but one visit) after a median of 15 weeks (range 9-26 weeks) postoperatively. After a median follow-up of 19 months 13 patients were completely symptom free. Two patients reported minor symptoms sporadically. One patient reported recurrence of symptoms. CONCLUSION Powered endonasal DCR with internal marsupialisation of the lacrimal sac is a safe and successful procedure for the treatment of nasolacrimal duct obstruction.