VELEMEGNA GOOD NEWS SOCIETY-BIDAR,KARNATAKA DR SALINS EYE HOSPITAL VELEMEGNA GOOD NEWS SOCIETY-BIDAR,KARNATAKA

Successful external DCR- Factors to be considered Dr Sybil Meshramkar Dr Praveen Sadanand

External DCR – gold standard for NLDO compared to endonasal or transcanalicular DCR Aim – consider factors affecting success of DCR Inclusion criteria – chr.dacryocystitis, mucocele, epiphora. Exclusion criteria - < 10yrs, nasal pathology, lid laxity, canalicular obstruction.

Lacrimal drainage disorders Chronic dacryocystitis (59) Lacrimal fistula (1) Mucocele (1) Previous failed DCR(1)

Discharge in eyes

Age and sex distribution males No. of patients <40yrs 1 40yrs-85yrs 6 females 15 40 Total 62

Surgical procedure Large osteotomy Suturing of anterior flaps Silicon tube intubation

Anterior Nasal Mucosal Flap

Sac Mucosal Flap

Silicon Intubation Tube

Silicon Tube Knotted

Knotted Silicon Tube Outside The External Nares

Nasal and Sac Mucosal Sutured

Silicon Intubation Tube Seen In The Puncta

Intraoperative complications Bleeding from incision site 2 Bleeding from nasal mucosa 8 Inappropriate place and size of osteotomy Difficulty fashioning the mucosal flaps 1

Intraoperative bleeding % of cases study 27.5% Mirzaman etal 13% Adravani etal 6.2% Gazemund K 0.6% Akhund 16.2% Present study

Late postoperative complications scar 4 Conjunctival irritation by tube 2 Non patency 1 Punctal/canalicular tear

Post operative complications Scar very faint - acceptance complications like migration of tube, rupture of central thinner segment, slitting of punctum – not found.

Postoperative results patent Non patent At 6 months (silicon tube removed ) 61 1 At 1 year

Intubation tube in left eye 98% success Success – resolution of symptoms like epiphora and discharge & a patent lacrimal system on irrigation. Silicon intubation facilitates epithelialization of DCR fistula. Intubation tube in left eye

Success rates with silicon intubation % of success Study conducted 97.5% Mirzaman etal 95% Tarbat etal 98.14% Talpur etal Advani etal 96% Besharati MR etal 98% Present study

Conclusion Meticulous surgery and proper identification of structures. Big osteotomy esp, younger patients. Silicon tube intubation in all. Tight opposition of anterior flaps.

Thank You