Comparative study of endoscopic versus external dacryocystorhinostomy

Introduction: Dacryocystorhinostomy (DCR) is the treatment of choice for acquired nasolacrimal duct obstruction, commonly caused by chronic dacryocystitis. DCR can be done either by external or endoscopic endonasal approach. External DCR is traditionally regarded as gold standard but endoscopic DCR is evolving as an equally effective alternative method with added advantages of less complications and early recovery.
Material & methods: This clinical prospective study was performed at pacific medical college and hospital, Udaipur during the period from January, 2014 to January, 2016. A total of 70 patients with the diagnosis of chronic dacryocystitis and nasolacrimal duct obstruction were included in the study.35 patients from the study underwent external DCR and rest 35 underwent endonasal DCR. Results of both the surgeries were assessed and compared.
Results: A total of 70 patients were included in the study out of which 56(80%) were female and 14(20%) were male. Mean age of the Patients was 56.5 years. Patency was achieved in 91.4% cases with external DCR and in 88.5% patients with endonasal DCR surgery. Long term anatomical patency and symptom relief (6-12 months postoperatively) was achieved in 80% patients with external DCR group and in 85.7% patients in the endonasal DCR group. The complication incidence was low and similar in both operations.
Conclusions: Results of both external and endonasal endoscopic DCR are comparable. The endoscopic DCR has the advantages that it leaves no scar and preserves the lacrimal pump system, unlike external DCR. An understanding of intranasal anatomy, however, is required for endoscopic surgery, with appropriate endoscopic training.