Evaluation of Endoscopic Dacrocystorhinostomy Using Microdrill with Creation of Mucosal Flaps

Purpose: To describe and assess the efficacy of endoscopic dacrocystorhinostomy using microdrill. This is a new technique that involves creation of a large rhinostomy and creation of mucosal flaps. The study involved a prospective nonrandomized interventional case series with short post-operative followup. Methods: A prospective series of 30 consecutive endonasal DCRs. Patients included in the study had nasolacrimal duct obstruction and had not had previous lacrimal surgery. The technique involved formation of a large bony ostium and apposition of nasal mucosal and lacrimal sac flaps. Surgery was performed by two surgeons (Ophthalmologist / otorhinolaryngologist). Follow-up assessment included nasoendoscopy as well as symptom evaluation. Success was defined as anatomical patency with fluorescein flow on nasoendoscopy and patency to lacrimal syringing. The average follow-up time was 6 months (range 2-9 months). Results: There were 30 DCRs performed on 30 patients (12 male, 18 female). The average age of the patients was 30 years (range 19-40 years). Common presentations were epiphora (95%) and/or mucocele (7%) and/or pyocele 3.3%. Septoplasty was required in 6 patients (20%). The surgery was anatomically successful in 28 cases (93.3%), but in 3 of them symptoms still present, so overall clinical success is present in 25 cases (83.3%). Conclusion: Endonasal DCR involves creation of a large ostium using microdrill and mucosal preservation for the construction of flaps. The anatomical success is 93.3% and is better than external DCR. Creation of a large ostium as well as mucosal flaps improves the efficacy of this endonasal technique.