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PubMedDate not supplied

Lacrimal drainage system obstruction: management and results obtained in 70 patients.

Causes and types of acquired obstruction of the lacrimal drainage system are discussed in 70 patients, as well as the results of their surgical treatment. Obstruction of the lacrimal drainage pathway, according to frequency, was due to: trauma (mainly naso-orbital and LeFort II fractures), post-inflammatory stenosis of the nasolacrimal duct, tumours and latrogenic injuries of the naso-lacrimal drainage system often following Caldwell-Luc operations of the maxillary sinus. The ages of patients ranged from 3-70 years. Canalicular obstruction was diagnosed in 9 (12.9%), obstruction of the lacrimal sac in 2 (2.8%), while obstruction of the naso-lacrimal duct in 50 (71.4%) patients, including 3 bilaterally. And in 9 (12.9%) patients, injury to the lacrimal system following excision of tumours of the eyelids and the medial canthal region occurred. In patients with canalicular obstruction intubation of the canaliculi was carried out and both ends of the drain were inserted into the nasal cavity for 6 months via a dacryocystorhinostomy. Total recovery was obtained in 44.5%. In lacrimal sac and nasolacrimal duct obstruction Dupuy-Dutemp's dacryocystorhinostomy was performed and 90.4% of the patients recovered. When fibrosis or extensive damage of the lacrimal sac had occurred, wide anastomosis with the nasal duct was indicated. After tumour excision, the lacrimal pathways were reconstructed by conjunctivo-rhinostomy, conjunctivo-sinusostomy or conjunctivo-dacryocystorhinostomy. In 40% of the patients who underwent conjunctivo-dacryocystorhinostomy a successful outcome ensued.

Adolescent↗

PubMed2005

Epidemiology of chronic dacryocystitis and success rate of external dacryocystorhinostomy in Nepal.

PURPOSE: To study the epidemiology of chronic dacryocystitis and the success rate of external dacryocystorhinostomy (DCR) in Nepal. PATIENTS AND METHODS: This is a retrospective descriptive and interventional case series. A total of 662 records of patients with chronic dacryocystitis due to nasolacrimal duct obstruction, who were treated by means of external DCR without bicanalicular silastic tube intubation, were studied. STATISTICS: Mean for age with standard deviation and confidence intervals were calculated. The significance of the difference in means was calculated using the unpaired t-test. RESULTS: Of 662 patients, 67.6% were female. The mean age of the patients was 27.4 +/- 13.7 years (SE = 0.53, 95% CI = 26.34-28.46). Chronic dacryocystitis due to nasolacrimal duct obstruction was found in 86 patients (13.0%) from the high hills (mean age = 35.3 +/- 11.4 years, 95% CI = 32.85-37.75), but most patients (576, 87.0%) were from the subtropical lowlands with a monsoon climate (mean age = 26.9 +/- 13.3 years, 95% CI = 25.8-28.0; p = < 0.01). An overall success rate of 88.6% (89.8% for high-hill patients and 87.4% for those from the lowlands) was obtained after DCR. CONCLUSION: Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.

Adolescent↗

PubMed1992

Lacrimal scintigraphy in the diagnosis of epiphora.

The value of lacrimal scintigraphy in the assessment of nasolacrimal duct obstruction was determined by comparing the results with syringing in 67 patients (83 eyes). As expected, of 28 lacrimal drainage systems which were obstructed on syringing, 23 (82%) had abnormalities of tear drainage on scintigraphy. However, in 55 lacrimal drainage systems that were patent on syringing, 19 (35%) were normal, but in 36 (65%) abnormalities not apparent on syringing were detected on scintigraphy. Thus scintigraphy is a very useful technique in the assessment of nasolacrimal duct obstruction particularly in systems patent on syringing. Since the site of obstruction can be determined, lacrimal scintigraphy can facilitate the planning of the appropriate surgery.

Humans↗

PubMedDate not supplied

The management of rhinitis in patients with functional epiphora: a randomized controlled crossover trial.

BACKGROUND: Nasolacrimal duct obstruction, secondary to inflammation of the nasal mucosa, can result in epiphora. This can be treated successfully with topical corticosteroids, avoiding the need for surgery. This study tests the hypothesis that treating clinically significant rhinitis improves the symptoms of epiphora. METHODS: A randomized controlled crossover trial (pilot study) was performed at the Cumberland Infirmary, Carlisle. Patients were assessed in an epiphora clinic by a consultant ophthalmologist and were included in the trial if they had bilateral functional epiphora, i.e., the nasolacrimal duct was patent on syringing. Twenty-three patients were then referred to a consultant otolaryngologist, where the severity of rhinitis and epiphora were assessed using visual analogue scales, subjective scoring, and clinical assessment. The 11 patients suitable for the study were randomized into two groups. The treatment group received nasal corticosteroids and the control group received no treatment, both groups changing treatment arms at a specified point. Subjective and objective scores were assessed at the beginning, midpoint, and end of each treatment period. RESULTS: Seven of 11 patients showed an improvement in epiphora scores with topical therapy. Six patients documented a symptomatic improvement. Eight patients showed an improvement in symptoms and signs of rhinitis, with two patients continuing on nasal corticosteroids for nasal symptoms only. There was a statistically significant improvement in both epiphora symptom scores and clinical findings of rhinitis in patients treated with nasal steroids (p = 0.021 and 0.019, respectively). CONCLUSION: Epiphora secondary to rhinitis can be treated successfully with intranasal steroids. Patients with epiphora should be asked about symptoms of rhinitis and should always have their nose examined for evidence of intranasal pathology.

Aged↗

PubMed1998

Dacryocystorhinostomy in south west England.

PURPOSE: To assess the pre-operative management, surgical technique employed, success rate and patient satisfaction following surgery in patients undergoing dacryocystorhinostomy (DCR) in South West England. METHOD: Two hundred and forty-two patients who underwent DCR were retrospectively studied. A telephone questionnaire was used to assess patient satisfaction in 100 patients. RESULTS: One hundred and thirteen (46%) patients had nasolacrimal duct obstruction, half of whom had a history of dacryocystitis, 70 (29%) had canalicular obstruction and 8 (3%) had mixed blockage. The site of blockage was not known or recorded in 51 patients (22%). Seventy-five (31%) patients underwent DCR, 151 (62%) DCR with insertion of silicon tubes, 9 (4%) DCR and Lester Jones tube, and 7 (3%) canaliculodacryocystorhinostomy (CDCR). Overall an 83.5% success rate was reported by the surgeons. The success rate for patients with a history of dacryocystitis was 98%, for nasolacrimal duct obstruction 96% and for canalicular obstruction 82%. When the site of blockage was not known or recorded the success rate was 60%. Where the name of the surgeon was not recorded there was a 15% successful outcome. Eighty per cent of patients reported some improvement in their symptoms following surgery. CONCLUSIONS: DCR is an effective surgical procedure with a high rate of patient satisfaction. Pre-operative identification of the site of the blockage is likely to improve surgical outcome.

Adolescent↗

PubMed1999

Anatomo-topographic landmarks on the lateral wall of nasal cavity used in endonasal surgery.

INTRODUCTION: A dissection of the lateral wall of nasal cavity that imitates a true endonasal operation was the design of the present study. The object of the study was by measuring the distance between a pivot landmark and important anatomical structures revealed successively during an endonasal operation to create additional highlights that will minimise the hazard of injuring vital structures. METHODS: Twenty anatomical preparations of sagittally sectioned heads from cadavers (elderly males of Bulgarian origin) were dissected to study the topographic relationships between the great paranasal cavities (maxillary, frontal, and sphenoidal sinus) and the ethmoidal labyrinth. Using punctum subnasale as a pivot landmark, the distances to crucial microendoscopic landmarks (i.e., nasolacrimal duct, uncinate process, ethmoidal bulla, base of the skull, anterior wall of the sphenoid sinus, orifice of the maxillary sinus) were measured at different angles to the horizontal plane. RESULTS: The mean distances from punctum subnasale to the natural ostium of the maxillary sinus and anterior wall of the sphenoidal sinus, measured at an angle of 30 degrees to the floor of the nasal cavity, were 48.25 +/- 0.75 and 67.105 +/- 0.794 mm, respectively. At an angle of 45 degrees, the mean distance to the nasolacrimal duct was 38.056 +/- 0.591 mm; to the uncinate process 45.25 +/- 0.57 mm; to the ethmoidal bulla 50.25 +/- 0.57 mm; and to the base of the skull 66.053 +/- 0.818 mm. Mean distance of 43.158 +/- 0.568 mm to the lacrimal sac and 60.25 +/- 0.68 mm to the base of the skull were measured at an angle of 60 degrees. CONCLUSION: The analysis of the results imply that the selected distances will contribute to a more precise application of this contemporary surgical method.

Aged↗

PubMed2001

Retrograde dacryocystography (RDC) utilizing a round-tipped needle.

Because the application of conventional anterograde dacryocystography has been restricted in cases with an intact lacrimal punctum, the indications are rather limited. The authors developed a new method for retrograde dacryocystography (RDC) using a hand-made round-tipped needle inserted directly into the orifice of the nasolacrimal duct. A 60 mm long aluminum tube (3 mm in diameter) was used to prepare the round-tipped needle. The distal portion of the tube was bent to an angle of about 80 degrees. The tip was then coated with synthetic resin adhesive to make it round. Following the insertion of the round-tipped needle directly into the inferior meatus, the tip was moved back and forth to find the orifice without visual observation. The complete insertion of the tip of the needle into the nasolacrimal duct was recognized by a fixed sensation of the tip. Contrast medium was then injected, and PA radiography was carried out. In the present paper, the authors report the usefulness of RDC, which is applicable even in cases of injury or obstruction in the upper lacrimal system. In 16 of 20 patients, the quality of the RDC images was judged as excellent. RDC can be carried out within a few seconds after acquiring the technical skills, and is thought to be a useful method, especially in cases of upper lacrimal injury.

Journal Article↗

PubMed2006

[Maxillary puncture: endoscopic assessment].

Frequency of the injury of the nasolacrimal duct ostium during maxillary puncture through the lower nasal passage was estimated endoscopically. Changes in the maxillary medial wall during the puncture were also studied. Anatomic features of the ostiomeatal complex which may contribute to development of chronic inflammation were determined. Forty one sinuses of 27 deceased middle-aged patients were examined within 24 hours after death. One third of patients in a random population had chronic maxillary inflammation caused by structural anomalies in the ostiomeatal complex. Half of the punctures were made with severe traumas of the nasolacrimal duct ostium. Natural anastomosis of the sinus did not function in about 20% cases. Accessory anastomosis in the posterior fontanelle was registered in 12.2% cases. The posterior fontanelle broke during sinus lavage in 3 cases. Indications for maxillary puncture in acute and chronic maxillary sinusitis should be considered much more carefully in the presence of stable alterations in the ostiomeatal complex and block of the natural anastomosis.

Aged↗

PubMed2002

Endonasal endoscopic dacryocystorhinostomy.

A review of endoscopic dacryocystorhinostomy (EDCR) performed in University Hospital from 1998 till early 2001 were carried out. They were reviewed for indication, functional results, complications and other associated factors. Eleven patients (6 female and 5 male) were reviewed. All had unilateral nasolacrimal duct (NLD) obstruction (6 right, 5 left). Their ages range from 6 to 73 years. All 11 had persistent epiphora while 4 had concurrent recurrent dacryocystitis with purulent discharge. Two patients had history of lacrimal sac abscess that needed drainage. Ten patients had the procedure performed successfully. Functional results were excellent in 8 patients (80%) while two patients still had occasional epiphora although markedly reduced. Complications include synachae (1 patient), premature dislodgement of Jones tube (1 patient) and impacted tube in a child. Our experience with EDCR concludes it to be an easy, efficient treatment for nasolacrimal duct obstruction with minimal complications.

Adolescent↗

PubMed2003

Docetaxel-induced histologic changes in the lacrimal sac and the nasal mucosa.

PURPOSE: To identify histopathologic changes in the lacrimal sac and the nasal mucosa caused by docetaxel in 3 patients with canalicular narrowing and nasolacrimal duct obstruction. METHODS: Small case series. Lacrimal sac and nasal mucosal specimens were obtained at the time of dacryocystorhinostomy or during silicone intubation to correct epiphora in 3 patients receiving docetaxel. Histologic evaluation was performed. RESULTS: Extensive fibrotic changes in the stroma of the lacrimal sac and the nasal mucosa were the prominent histologic features in all 3 patients. A biopsy specimen was taken from the lower portion of the nasal mucosa (near the inferior turbinate) in one patient at the time of silicone intubation and showed both clinical and histologic evidence of keratinization with marked epidermalization of the surface epithelium, thickening, and parakeratosis of the squamous epithelium. CONCLUSIONS: Nasolacrimal duct obstruction secondary to treatment with docetaxel may be in part due to stromal fibrosis in the mucosal lining of the lacrimal drainage apparatus.

Aged↗

PubMed1995

Morphologic changes in the nasal cavity associated with sialodacryoadenitis virus infection in the Wistar rat.

A sequential study of lesions of the nasal cavity associated with sialodacryoadenitis virus (SDAV) infection was made in the laboratory rat. Wistar rats were intranasally inoculated with approximately 10(3) TCID50 of the coronavirus SDAV. Transverse sections of four regions of the nasal cavity from inoculated and control animals were examined by light microscopy and immunohistochemistry at 2, 4, 6, 8, 10, and 14 days postinoculation (PI). Lesions were observed in the following regions of the upper respiratory tract: respiratory epithelium, transitional epithelium, olfactory epithelium, nasolacrimal duct, vomeronasal organ, and the submucosal glands of the nasal passages. In general, in structures lined by ciliated epithelial cells, there was focal to segmental necrosis with exfoliation of affected cells and polymorphonuclear cell infiltration during the acute stages, progressing to squamous metaplasia during the reparative stages. Repair in these regions was essentially complete by 14 days PI. In the olfactory epithelium and the vomeronasal organ, there was interstitial edema with necrosis and exfoliation of epithelial cells and minimal to moderate inflammatory cell response during the acute stages. Residual reparative lesions were still evident in the olfactory epithelium, the columnar epithelium and neuroepithelium of the vomeronasal organ, and the nasolacrimal duct at 14 days PI. Viral antigen was demonstrated by immunohistochemistry in all regions during the acute stages of the disease, with the exception of the vomeronasal organ. In view of these findings, infections of the respiratory tract with viruses such as SDAV could have significant effects on functions such as olfaction and chemoreception for > or = 2 weeks postexposure in this species.

Animals↗

PubMed2003

[Lacrimal duct probing in young children with a congenital lacrimal duct obstruction at the Utrecht University Medical Center: generally an effective treatment].

OBJECTIVE: To assess the results of lacrimal duct probing in young children with epiphora, due to a congenital nasolacrimal duct obstruction. DESIGN: Retrospective, descriptive. METHOD: Data were collected from medical dossiers on the results of lacrimal duct probing in children (0-48 months) with epiphora that was done in the period from January 1, 1997 to December 31, 2001 at the University Medical Centre in Utrecht, the Netherlands. The percentage of eyes that showed complete resolution of symptoms three months after the final probing was calculated. RESULTS: Of the 89 children who had undergone lacrimal duct probing, seven were excluded and in three children (six eyes) the data could not be retrieved. In 96 of the remaining 116 eyes (83%), the symptoms disappeared: this included 96% of the age group 0-12 months (n = 25), 85% of the 13-24 months-olds (n = 55), 77% of the 25-36 months-olds (n = 22) and 57% of the 37-48 months-olds (n = 14). No complications of probing were seen. CONCLUSION: In most children in the various age groups, epiphora disappeared. Thus, children do not need to be probed in the first year of life out of fear of failure at an older age. Whether or not probing shortens the duration of epiphora cannot be determined on the basis of either this study or the literature.

Age Factors↗

PubMed2000

Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy.

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tube intubation (STI). We prospectively investigated 158 patients with lacrimal obstruction in two groups, one of which comprised 108 patients treated primarily with intranasal endoscopic DCR by experienced surgeons and the other comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 94.4% in experienced hands and 58.0% in inexperienced hands. The endoscopic examination of six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 failures out of 50 patients in the second group: granulation tissue in 2 cases, fenestration to the nasolacrimal duct instead of the sac in 6 cases, synechia between the lateral nasal wall and the middle turbinate in 2 cases, bony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 4 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membranous sac wall was the reason. DCR and STI can be performed for primary treatment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and the synechia between the lateral wall and the middle turbinate are the most common causes of failure.

Adult↗

PubMed2003

Endonasal laser dacryocystorhinostomy: its role in anticoagulated patients.

OBJECTIVE: To report the results of endoscopic laser-assisted dacryocystorhinostomy in anticoagulated patients. STUDY DESIGN: A retrospective study of 16 consecutive anticoagulated patients with distal nasolacrimal duct obstruction treated by endoscopic laser-assisted dacryocystorhinostomy. METHODS: A case note review was made of all patients treated with endoscopic laser-assisted dacryocystorhinostomy who were taking coumadin in two centers between 1993 and 2000. The parameters of age, gender, indications for surgery, surgical findings, complications, and outcome were analyzed. The mean follow-up time was 14 months (range, 9-26 mo). RESULTS: Fifteen of the 16 patients who were treated had an eventual successful outcome, but 6 patients required revision surgery. The patient whose symptoms were not improved was shown to have functional epiphora. No patient had a problem with primary or secondary epistaxis, and no patient required admission. A major benefit was the lack of disruption of anticoagulant therapy. CONCLUSIONS: Endoscopic laser-assisted dacryocystorhinostomy is a safe, efficient technique for the relief of distal nasolacrimal duct obstruction in anticoagulated patients. Not only does it avoid any disruption to their anticoagulant therapy, but it also can be performed as an outpatient procedure.

Adult↗

PubMed2001

Value of nasal endoscopy and probing in the diagnosis and management of children with congenital epiphora.

BACKGROUND: Congenital nasolacrimal obstruction is usually the result of failure of canalisation of the distal end of the nasolacrimal duct. The most common outcome is spontaneous resolution, but some children do require surgical treatment by probing. Probing is a blind procedure with a recognised failure rate. METHODS: In 52 lacrimal systems of 40 children nasal endoscopy was combined with a "stepwise" systematic probing in an attempt to improve the outcome and reduce the number of repeat procedures. RESULTS: Combined nasal endoscopy and probing improved the understanding of outflow obstruction in young children. The success of the procedure depended upon the level of the obstruction within the outflow system. Formation of a false passage was seen in six cases (15%). The probe was rerouted under direct visualisation in these cases to form a functioning passage. Reasons for failure were identified in those who did not have a successful outcome and only one repeat procedure was required. CONCLUSION: Using nasal endoscopy the area of lacrimal outflow obstruction at the lower end of the nasolacrimal duct can be observed directly and it is possible to guide the progress of probing under direct vision. This gives better information about the nature of the obstruction, minimises the formation of false passages, and allows a wider range of treatment options under a single anaesthetic.

Algorithms↗

PubMed2000

Innervation of the cavernous body of the human efferent tear ducts and function in tear outflow mechanism.

The lacrimal sac and nasolacrimal duct are surrounded by a wide cavernous system of veins and arteries comparable to a cavernous body. The present study aimed to demonstrate the ultrastructure of the nervous tissue and the localisation of neuropeptides involved in the innervation of the cavernous body, a topic not previously investigated. Different S-100 protein antisera, neuronal markers (neuron-specific enolase, anti-200 kDa neurofilament), neuropeptides (substance P, neuropeptide Y, calcitonin gene-related peptide, vasoactive intestinal polypeptide) and the neuronal enzyme tyrosine hydroxylase were used to demonstrate the distribution pattern of the nervous tissue. The ultrastructure of the innervating nerve fibres was also examined by means of standard transmission electron microscopy. The cavernous body contained specialised arteries and veins known as barrier arteries, capacitance veins, and throttle veins. Perivascularly, the tissue was rich in myelinated and unmyelinated nerve fibres in a plexus-like network. Small seromucous glands found in the region of the fundus of the lacrimal sac were contacted by nerve fibres forming a plexus around their alveoli. Many nerve fibres were positive for S-100 protein (S 100), neuron-specific enolase (NSE), anti-200 kDa neurofilament (RT 97), calcitonin gene-related peptide (CGRP), substance P (SP), tyrosine hydroxylase (TH), and neuropeptide Y (NPY). Vasoactive intestinal polypeptide (VIP) immunoreactivity was only demonstrated adjacent to the seromucous glands. Both the density of nerve fibres as well as the presence of various neuropeptides emphasises the neural control of the cavernous body of the human efferent tear ducts. By means of this innervation, the specialised blood vessels permit regulation of blood flow by opening and closing the lumen of the lacrimal passage as effected by the engorgement and subsidence of the cavernous body, at the same time regulating tear outflow. Related functions such as a role in the occurrence of epiphora related to emotional responses are relevant. Moreover, malfunction in the innervation of the cavernous body may lead to disturbances in the tear outflow cycle, ocular congestion or total occlusion of the lacrimal passages.

Adult↗

PubMed2002

Involvement of the lacrimal drainage system by leukemia or lymphoma.

PURPOSE: To determine the clinical characteristics and outcomes of patients with leukemic or lymphomatous involvement of the lacrimal drainage system (LDS). METHODS: A computerized retrieval system was used to identify patients with histologically proven leukemic or lymphomatous involvement of the LDS. Medical records were reviewed. RESULTS: Biopsies of the lacrimal sac or nasolacrimal duct obtained during dacryocystorhinostomies (DCR) performed at the Mayo Clinic (Rochester, Minnesota) between January 19, 1989, and August 26, 1997, were positive for leukemia or lymphoma in 11 patients (15 LDS). Ten patients had previously diagnosed leukemia or lymphoma; the interval between the diagnosis of systemic disease and DCR averaged 5.8 years (range, 7 months to 13 years; median, 5 years). The median age at the time of LDS involvement was 72 years (range, 49 to 85 years). Seven patients (64%) were women, and all were white. The median postoperative follow-up after DCR was 38 months (range, 10 to 65 months). Eight patients had leukemic infiltration of the LDS, 2 patients had B-cell lymphoma, and 1 patient had cutaneous T-cell lymphoma. Four patients had bilateral LDS involvement, and the remainder had unilateral disease (right eye, 1 patient; left eye, 6 patients). The most common initial presentation, in 9 patients (82%), was epiphora. Lacrimal irrigation of 2 LDS was deferred because of acute dacryocystitis. Of the remaining 13 systems, 8 were completely obstructed. The blockage was low (in the lower sac or in the nasolacrimal duct) in 6 systems and high (in the upper sac or common internal punctum) in 2 systems. Four LDS were anatomically patent to irrigation but were functionally obstructed. Chemotherapy was the primary treatment in 7 patients, whereas 4 patients underwent radiation therapy. Nine patients responded well to treatment, with alleviation of signs and symptoms, and none of these patients had local recurrence during the follow-up interval. CONCLUSIONS: Leukemic or lymphomatous involvement of the LDS is an unusual cause of tearing in elderly patients, but it should be suspected in patients with known systemic disease. Treatment comprising multiple interventions improves the signs and symptoms of this complication of lymphoproliferative disorders in most patients.

Aged↗

PubMed2002

A retrospective comparison of endonasal KTP laser dacryocystorhinostomy versus external dacryocystorhinostomy.

We retrospectively reviewed all primary external dacryocystorhinostomies (DCRs) and endonasal KTP laser DCRs performed for epiphora as a result of nasolacrimal duct obstruction in our unit between 1993 and 2000. Forty-nine patients underwent an external approach and 76 endonasal laser procedures were performed. The success rate of the external group was 94% with a mean follow-up of 9 months. In contrast, the endonasal group's success rate was 64% with a mean follow-up of 12 months. This difference reached statistical significance (P = 0.0002). However, when including revision procedures, the success rate in the endonasal group increased from 64% to 82%. The success rate in the endonasal group improved from 50% in the first 38 cases to 79% in the last 38 cases (P = 0.0084), thereby demonstrating a learning curve. Our study confirms external DCR as the 'gold standard' for a successful outcome. However, the endonasal technique has significant advantages, including being a quicker procedure with less morbidity, no cutaneous scar, and being more amenable to a bilateral procedure, daycase surgery and local anaesthetic. We are persisting with the endonasal technique because of its advantages but have moved towards more 'cold steel' techniques in an effort to improve results and emulate other series. In conclusion, for nasolacrimal duct obstruction, the endonasal technique is our approach of choice, with revision surgery if necessary, and the external technique is held in reserve.

Adolescent↗