International Journal of Ophthalmic PathologyISSN: 2324-8599

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Comparative study between conventional external dacryocystorhinostomy and transconjunctival dacryocystorhinostomy for management of primary acquired nasolacrimal duct obstruction


Kareem Bakr Elessawy, Sameh H Abdelbaky, Rania A Abdelslam and Haytham E Nasr

Cairo University, Egypt

: Int J Ophthalmic Pathol

Abstract


Aim: To study the efficacy of scarless dacryocystorhinostomy through inferomedial transconjunctival approach in comparison to traditional external dacryocystorhinostomy. Setting: Tertiary ophthalmic referral centre, Cairo, Egypt. Design: Prospective randomized comparative interventional case series. Method: 40 eyes suffering from nasolacrimal duct obstruction that needed DCR were included in the study. Patients were randomly divided into two groups. Group A included 20 eyes who underwent conventional DCR surgery via skin incision while group B included 20 eyes who underwent transconjunctival DCR. Results: Tear meniscus height decreased in both groups after the surgery with more reduction in group A. Patient satisfaction improved in both groups after the surgery with more improvement in group A. In group A, total success was obtained in 19 cases while one case showed partial success. No failures were reported. On the other hand, group B had 17 cases with total success, two cases with partial success, and failure in only one case. No major intra-operative complications were encountered in external DCR group. However, complications were reported in 50% of cases in transconjunctival approach. Conclusion: External DCR remains the most successful surgery in the management of complete nasolacrimal duct obstruction. While, the trans-conjuntival approach may be considered as a new tool that can be used in specific patients as skin diseases, tendency for keloid formation or patient preference with comparable results to external DCR. Also, it can be converted into external approach when needed.

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