How transcanalicular DCR helps nasolacrimal obstruction
Laser-assisted transcanalicular dacryocystorhinostomy is a quick, minimally invasive procedure that may yield a higher success rate than more traditional dacryocystorhinostomy approaches.
By Brigita Drnovšek-Olup, MD, PhD, Special to Ophthalmology Times
Ljubljana, Slovenia-Nasolacrimal drainage obstruction (NLDO) is a common disorder that may be congenital or acquired. Symptoms include excessive tearing, pain, recurrent conjunctivitis, bloody tears, dacryocystitis and general irritation of the eye.
In infants, NLDO typically arises as a result of problems in normal development. In adults, NLDO can be classified as primary or secondary. Primary acquired NLDO affects more females than males, likely explained by the fact that women have smaller lower nasolacrimal fossa and middle nasolacrimal ducts than men; hormonal fluctuations may also contribute to the development of the condition.
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Secondary acquired NLDO, meanwhile, may be caused by a number of factors including a bacterial, fungal or viral infection, inflammation (e.g., Wegener granulomatosis and sarcoidosis), neoplasms, sinus disease/sinonasal surgery, systemic chemotherapy, radiation, presence of foreign bodies, use of eye drops and trauma-to name but a few.
Treatment strategies
In infants, NLDO usually heals by itself within the first year; however, in adults, some form of intervention is almost always necessary, ranging from simple massage to surgical interventions such as balloon catheter dilatation, conjunctivodacryocystorhinostomy, inferior meatus surgery, placement of a stent, or dacryocystorhinostomy. The latter of these approaches, dacryocystorhinostomy (DCR), is the treatment of choice for many patients and may be roughly classified as external or endonasal.
Endonasal DCR, which involves the creation of a large ostium and construction of nasal and lacrimal sac mucosal flaps, has grown in popularity, in part due to advances in technology which permit improved visualization of the lateral nasal wall, but also because endonasal DCR (unlike external DCR) does not require any incisions, thus external scarring, which many patients find distressing, is avoided. It also has a shorter procedure time and a faster recovery rate than external DCR.
Not surprisingly then, endonasal DCR is becoming the treatment of choice for obstructions of the nasolacrimal duct and also as a revision procedure for failed classic DCR.1
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