EXTERNAL DACRYOCYSTORHINOSTOMY VERSUS ENDOSCOPIC ENDONASAL DACRYOCYSTORHINOSTOMY: A COMPARATIVE STUDY

Background: Dacryocystitis is the inflammation of the lacrimal sac due to nasolacrimal duct obstruction. Chronic dacryocystitis is a constant threat to cornea and orbital soft tissue & always dictates surgery for correction of symptomatology. The gold standard procedure of choice for the treatment of epiphora is Dacryocystorhinostomy. This study proposes to evaluate and compare the surgical outcome of external DCR and endoscopic endonasal DCR. METHODS: A Retrospective, comparative, randomized interventional study was conducted from January 2012 to December 2013. 40 diagnosed cases of chronic dacryocystitis were randomized into two groups. Group A included 20 patients who underwent external Dacryocystorhinostomy and group B included the rest of the 20 patients who underwent endoscopic endonasal Dacryocystorhinostomy. RESULTS: In group A patients, 9 cases had bleeding during surgery, tearing of the anterior nasal flap was seen in 5 cases and punctal laceration in 4 cases. In group B patients 3 cases had bleeding, 5 cases had Trauma to the middle turbinate while accidental entry into anterior ethmoidal cells was in 4 cases. In 8 cases there was difficulty in making a bone window. In group A patients, duration of surgery is comparatively more than in group B. In post-operative period group A patients, had epistaxis, rhinostomy site closure, hypertrophied external scar and medial canthi damage as its complication while group B epistaxis, nasal Synechea, intra nasal granulation at the ostium are major complication. After a period of 3months by syringing the lacrimal sac of the patients in group A patients, 18 patients had a patent sac (success rate is 90%). In group B patients, 16 patients had a patent sac (success rate being 80%). CONCLUSION: DCR either by external or endonasal route can be considered for treatment of nasolacrimal duct obstruction. The external route has an easy and short learning curve with reduced cost of equipment. Whereas endoscopic DCR is time saving, avoids a facial scar and injury to the neighboring structures like the medial palpebral ligament and the angular facial vessels. In our study, the success rate of Endonasal DCR and External DCR are almost equal and comparable. This indicates that these two different DCR techniques are acceptable alternatives. However it's the preference of the patient, resource available and the surgeon himself to decide the right surgical option to axe the disease.