|Year : 1969 | Volume
| Issue : 2 | Page : 55-58
Scope of dacryocystorhinostomy
RC Saxena, KC Garg
Department of Ophthalmology, King George's Medical College, Lucknow, India
|Date of Web Publication||8-Jan-2008|
R C Saxena
Department of Ophthalmology, King George's Medical College, Lucknow
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Saxena R C, Garg K C. Scope of dacryocystorhinostomy. Indian J Ophthalmol 1969;17:55-8
After the first description of Dacryocystorhinostomy by Toti in 1904, a revolutionary change has come in the treatment of chronic dacryocystitis. Although various modifications have been suggested concerning the original technique of Toti, but the method of DupuyDutemps and Bourgeut is widely followed because of its simplicity and higher incidence of success. After the latter half of the third decade of this century dacryorhinostomy has gained momentum and less number of sacs are being removed these days.
This operation has been advocated in various clinical conditions of dacryocystitis. Sardas et al have tried this technique in a variety of cases with 97.5% success. The authors of this paper realising its wider scope have tried this operation in various types of clinical conditions of Dacryocystitis and have established its value in each individual group.
Herewith we present a review of 86 cases on whom Dacryocystorhinostomy has been done in the past three years. These cases have been collected from the ophthalmic and E.N.T. sections of Gandhi Memorial and Associated Hospitals, Lucknow.
| Review of the cases|| |
Out of 86 cases of the present series, 70 patients (81.5%) were females and 16 patients (18.5%) were males. [Table - 1].
Majority of the patients came in the second, third and fourth decade of life, out of which a maximum number of 36 belonged to the fourth decade. [Table - 1].
Out of 86 cases only 9 (10.4%) had bilateral involvement, whereas 77 cases (89.6%) had unilateral involvement. Thus the number of eyes operated were 95.
The clinical presentations of the cases operated upon with their probable causes are indicated in [Table - 2].
Dacryocystography with 70% of Diaginol (Sodium Acetriozoate) was done in all the cases to assess the size and shape of the sac and the site of blockage in lacrimal passages. It was of great help to find out the amount of atonia in group VI. Rough assessment regarding the size of the sac was also made by the amount of pus regurgitating through the puncta. In all the cases a thorough E.N.T. check was done and the health of the underlying bone was assessed radiographically.
The cases were operated under general anesthesia by preference. The technique of operation was based on Dupuy-Dutemps and Bourgeut's description.
First post-operative syringing was done with 4% sodium citrate solution on the third day. Then it was repeated on alternate days till the 7th day. After this, weekly syringing was done with Penicillin lotion (10,000 units/ cc.) for 1 month and then monthly syringing was done for another 5 months.
After surgery a follow up of the patient was carried out upto six months and the results were assessed by the amount of epiphora, regurgitation and patency on syringing. A detailed description of results of 95 eyes operated has been charted in [Table - 3], showing complete success in 83 eyes (87.4%), partial success in 8 eyes (8.4%) and failure in 4 eyes 4.2%).
| Discussion|| |
In the present series of 86 cases, operation of Dacryocystorhinostomy has been done in 95 eyes. The cases include a variety of clinical conditions of dacryocystitis with known and unknown etiology. The results of these cases have been charted as cases of complete success, partial success, and failures. The cases which showed no epiphora or regurgitation and in whom lacrimal passages were patent on syringing were grouped as cases of `complete success'. The cases which showed slight amount of epiphora with no regurgitation and in whom syringing was either partially or fully patent, were grouped under `partial success'. The cases in which epiphora and regurgitation continued with blocked lacrimal passages were considered as `failures'.
The group of chronic dacryocystitis regurgitating into conjunctival sac included 5 cases which were due to congenital non-canalization of nasolacrimal duct. In them no difficulty was encountered on the operation table. This group showed 93% complete success, 3.5% partial success and 3.5% failures.
The cases of acute dacryocystitis rendered quiescent had a certain amount of oedema and adhesions. They had a greater amount of haemorrhage and were difficult to operate. In this group, complete success was achieved in 66.7% cases and only partial success in 33.3% cases.
The cases of chronic dacryocystitis with mucocele were easy to operate. The results of 85.8% complete success and 14.2% partial success are quite encouraging. The higher incidence of success here was mainly due to a larger size of hole in the bone which drained the lacrimal fluid efficiently inspite of atonicity of the sac.
The cases of chronic dacryocystitis with a fistula responded very well to this method, though fistulae were left untouched. On first syringing, the fluid regurgitated through the fistulae, but from fifth day of the operation they showed signs of healing, and after the seventh day fistulae disappeared completely. This indicates that fistulectomy is not always essential. 85.8% complete success and 14.2% partial success in this group is remarkable.
The cases of blocked nasolacrimal duct were those which came with no regurgitation. Syringing indicated blockage of nasolacrimal duct. The size of the sac in this group was invariably smaller due to which a larger hole in the bone was preferred. The results of complete success in 87.5% and partial success in 12.5% are very heartening.
The cases of chronic dacryocystitis with atonia of sac were those which came with epiphora with regurgitation both in the conjunctival sac and the nose. Syringing indicated partial patency of nasolacrimal duct. 100% complete success in this group is highly encouraging.
The operation of Dacryocystectomy is still practised by some ophthalmic surgeons in our country, and we do get a few cases of recurrence of dacryocystitis. The cases which are due to partial resection of sac, develop a pouch of fibrous tissue and show regurgitation. If under roentgenography the underlying bone was found healthy and if dacryocystography indicated moderate size of residual sac with or without a cicatricial pouch, then the cases were subjected to Dacryocystorhinostomy with slight changes in the original technique of Dupuy-Dutemps and Rourgeut. Inspite of a greater amount of bleeding, difficulty due to adhesions and also in stitching the flaps in nearly every case, we achieved 63.6% complete success, 18.2% partial success and 18.2% failure in this group.
Thus the overall results in the present series were 87.4% complete success, 8.4% partial success, 4.2% failures. These results as compared with those of Dupuy-Dutemps (94.8%), and of Averbach and Ivanova (97%) are somewhat inferior because we have tried this method in a greater variety of pathological sacs. The results in our series as compared with those of Sardas et al who tried this operation in various clinical conditions are also low. The higher incidence of only partial success in our series is attributed by us to atonicity of the sac in the majority of the cases. In a few cases adhesion formation was responsible in rendering passages partially patent.
Our series include 9 cases of bilateral involvement and we found no difficulty in operating on both sides in two cases even in one sitting.
Lower age limit in our series was sl years. In the experience of Dena it was 4 months. In our opinion ages of a few months to one year are too early to advocate this major surgery in routine cases of congenital non canalisation of nasolacrimal duct. To us an age of 2 years or so appears more desirable. The upper age limit, however, has no limitation.
| Summary|| |
A review of 86 cases operated for Dacryocystorhinostomy has been given in detail. The cases selected belonged to various clinical presentations of sac diseases. The present work indicates a wider scope of Dacryocystorhinostomy with a high incidence of success.
| References|| |
AVERBACH and IVANOCA-An., d'Oc., Cl xxii, 913, (1935).
DENA, F. P. - Proceedings of New York Society for Clinical Ophthalmology, April 5, 1957, Am. J. Ophth., 46, 86, (1958).
DUPUY-DUTEMPS-An., d'Oc., clxx, 361, (1933).
DUPUY-DUTEMPS and BOURGEUT -An. d'Oc., clviii, 241, (1921).
SARDA et al - B.J.O., 45, 138-143,
TOTI, A.-Clin. Mod. Firenze, 10, 385, (1904).
[Table - 1], [Table - 2], [Table - 3]