• 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)

Age and sex distributionmales No. of patients

<40yrs 1

40yrs-85yrs 6

females

<40yrs 15

40yrs-85yrs 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 complicationsBleeding from incision site 2

Bleeding from nasal mucosa 8

Inappropriate place and size of osteotomy

0

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 complicationsscar 4

Conjunctival irritation by tube 2

Non patency 1

Punctal/canalicular tear 0

Post operative complications

• Scar very faint - acceptance• complications like migration of tube, rupture

of central thinner segment, slitting of punctum – not found.

Postoperative resultspatent Non patent

At 6 months (silicon tube removed )

61 1

At 1 year 61 1

• 98% success• Success – resolution of symptoms like

epiphora and discharge & a patent lacrimal system on irrigation.

• Silicon intubation facilitates epithelialization of DCR fistula.

Success rates with silicon intubation

% of success Study conducted

97.5% Mirzaman etal

95% Tarbat etal

98.14% Talpur etal

95% 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.