Outcome of Endoscopic Endonasal Dacryocystorhinostomy in Karbala, Iraq


background: Dacryocystorhinostomy (DCR) is an operation that has been used for the past 100 years. Endoscopic endonasal DCR is less invasive than external DCR; therefore, it has rapidly gained acceptance for the treatment of intractable nasolacrimal duct obstruction and chronic dacryocystitis. Many ophthalmologists still believe that external DCR is the gold standard treatment for nasolacrimal duct obstruction. However, because incision of the facial skin is required, patients are reluctant to undergo external DCR.Objectives: To analyze the results of Endonasal Endoscopic Dacryocystorhinostomy regarding complications and success rate. Methods: A prospective study was carried out on 26 patients at Department of Otolaryngology, Al-Hussian Teaching Hospital, Karbala during the period September 2013 to November 2016. Patients presented with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in this study. Endonasal Endoscopic Dacryocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacryocystorhinostomy tube. Complications during and after the procedure were recorded. Results: Out of total 26 patients 23 (88%) were females and 3 (12%) were males (F:M=7.7:1). The age range was 6 to 60 years with a mean age of 33 years. The duration of symptoms ranged between 8 months to 6 years. There were only 2 (8%) patients had bilateral symptoms while the other 24 (92%) patients had unilateral symptoms. Average duration of endoscopic DCR was 60 minutes. DCR tube was removed 6 months after operation in 24 (92%) patients and in 2 (8%) patients, it was removed after 3 months. Complications encountered during and after surgery were, haemorrhage in 4 (15%), ecchymosis in 2 (8%), nasal adhesions in 2 (8%), granulations at osteotomy site in 1 (4%), retrograde tube displacement in 2 (8%) patients. Overall, 24 (92%) patients were symptom-free 6 months after the removal of the tube. Out of the remaining 2 (8%) patients, one patient underwent revision surgery and was symptom-free 6 months after the removal of the tube whereas the other refused revision surgery. Overall success rate of endonasal DCR was 25 (96%). Conclusions: Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.