Dr Zeeshan Ahmad

M.S.(ENT, PGY3)

Department of ENT, NMCH, Patna.29.01.2015

DCR

Opthalmologist -----------> Otolaryngologist

Big responsibility for ENT to give ~100% result

For 100% result – proper case selection

These features ensure success :-

Epiphora duration <1 year

No history of pus or abscess

Prefer female patient

Able to do nasal douching

Can come for follow up regularly

No Opthalmic comorbidities

These features ensure success :-

Regurgitation test positive

Hard stop on probing

Distended sac

Syringing yields mucoid material slowly

DNS to the opposite side

Can do all the cases

But caution is required in following :-

Gross DNS to Operative side

Revision case

Case with suppuration

Common canalicular block

Steroid - if too inflamed

Regular preop syringing

Antibiotics oral/topical

Control nasal allergy

Bone removal – bone removal – bone removal

Expose upto - sac fundus

Incise after tenting with lacrimal probe

Fashion the sac like a book

Tuck the sac beneath nasal mucosa

Achieve hemostasis without packing

Use stent in revision cases

DCR has moved from the hands of opthalmologists to the Otolaryngologist

not just because it has scar advantage

but it is also more physiological and

epistaxis is better controlled.

Our series - 14 cases – 2 failures

one due to CC block and other due to inefficient bone removal.

05.02.15 Dr Sonu Kr SinghM.S.(ENT,PGY3)

Juvenile Nasopharyngeal

Angiofibroma – origin,

spread, management