International Ophthalmology

, Volume 36, Issue 1, pp 105–110 | Cite as

Safety and efficacy of adjunctive intranasal mitomycin C and triamcinolone in endonasal endoscopic dacryocystorhinostomy

  • Emmy Y. Li
  • Andy C. Cheng
  • Alex C. Wong
  • Amy M. Sze
  • Hunter K. Yuen
Original Paper


One of the common causes of failure in dacryocystorhinostomy for nasolacrimal duct obstruction (NLDO) is mucosal scarring and fibrosis around the ostium. Steroid and mitomycin C (MMC) can potentially reduce scarring by their action on the inflammatory and proliferative phase of wound healing, respectively. The purpose of this study is to evaluate the safety and efficacy of combined usage of adjunctive MMC and intranasal triamcinolone (TA) in endonasal endoscopic dacryocystorhinostomy (EE-DCR). This is a retrospective interventional case series. All patients underwent mechanical EE-DCR in two regional hospitals in Hong Kong from January 2005 to December 2006 were included. All received intraoperative MMC application for 5 min and gelfoam soaked with TA onto the ostium. Main outcome measures include the anatomical and functional success rate at follow-up at least 6 months after operation. Other outcomes include complications occurred during and after operation. A total of 73 EE-DCR were performed in 69 patients. Three patients had simultaneous bilateral DCR; one had sequential DCRs for both sides. At the last follow-up, anatomical success was achieved in 68 cases (93 %) and both anatomical with functional success in 67 cases (92 %). No major complication was observed. Minor complications included asymptomatic mucosal adhesion between the nasal septum and lateral nasal wall in one patient and moderate secondary hemorrhage in another. EE-DCR with adjunctive MMC and TA is a safe and successful procedure for the treatment of NLDO.


Endoscopic dacryocystorhinostomy Nasolacrimal duct obstruction Mitomycin C Triamcinolone 


Conflict of interest

No conflicting relationship exists for any author.


  1. 1.
    Lee DW, Chai CH, Loon SC (2010) Primary external dacryocystorhinostomy versus primary endonasal dacryocystorhinostomy: a review. Clin Exp Ophthalmol 38(4):418–426CrossRefGoogle Scholar
  2. 2.
    Hartikainen J, Grenman R, Puukka P, Seppa H (1998) Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology 105(6):1106–1113PubMedCrossRefGoogle Scholar
  3. 3.
    Moore WM, Bentley CR, Olver JM (2002) Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser. Ophthalmology 109(8):1575–1582PubMedCrossRefGoogle Scholar
  4. 4.
    Dolman PJ (2003) Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Ophthalmology 110(1):78–84PubMedCrossRefGoogle Scholar
  5. 5.
    Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA (2005) External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology 112(8):1463–1468PubMedCrossRefGoogle Scholar
  6. 6.
    Barmettler A, Erlich J, Lelli G Jr (2013) Current preferences and reported success rates in dacryocystorhinostomy amongst ASOPRS members. Orbit 32(1):20–26PubMedCrossRefGoogle Scholar
  7. 7.
    Tsirbas A, Wormald PJ (2003) Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Br J Ophthalmol 87(1):43–47PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Codere F, Denton P, Corona J (2010) Endonasal dacryocystorhinostomy: a modified technique with preservation of the nasal and lacrimal mucosa. Ophthalmic Plast Reconstr Surg 26(3):161–164CrossRefGoogle Scholar
  9. 9.
    Zilelioglu G, Ugurbas SH, Anadolu Y, Akiner M, Akturk T (1998) Adjunctive use of mitomycin C on endoscopic lacrimal surgery. Br J Ophthalmol 82(1):63–66PubMedCrossRefGoogle Scholar
  10. 10.
    Prasannaraj T, Kumar BY, Narasimhan I, Shivaprakash KV (2012) Significance of adjunctive mitomycin C in endoscopic dacryocystorhinostomy. Am J Otolaryngol 33(1):47–50PubMedCrossRefGoogle Scholar
  11. 11.
    Lee DA (1994) Antifibrosis agents and glaucoma surgery. Invest Ophthalmol Vis Sci 35(11):3789–3791PubMedGoogle Scholar
  12. 12.
    Dolmetsch AM (2010) Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in nasolacrimal duct obstruction in adults. Ophthalmology 117(5):1037–1040PubMedCrossRefGoogle Scholar
  13. 13.
    Zeldovich A, Ghabrial R (2009) Revision endoscopic dacryocystorhinostomy with betamethasone injection under assisted local anaesthetic. Orbit 28(6):328–331PubMedCrossRefGoogle Scholar
  14. 14.
    Cheng AC, Wong AC, Sze AM, Yuen HK (2009) Limited nasal septoplasty by ophthalmologists during endonasal dacryocystorhinostomy: is it safe? Ophthalmic Plast Reconstr Surg 25(4):293–295CrossRefGoogle Scholar
  15. 15.
    Yigit O, Samancioglu M, Taskin U, Ceylan S, Eltutar K, Yener M (2007) External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results. Eur Arch Otorhinolaryngol 264:879–885PubMedCrossRefGoogle Scholar
  16. 16.
    Anijeet D, Dolan L, Macewen CJ (2011) Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev 19(1):CD007097Google Scholar
  17. 17.
    Woog JJ, Kennedy RH, Custer PL, Kaltreider SA, Meyer DR, Camara JG (2001) Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology 108(12):2369–2377PubMedCrossRefGoogle Scholar
  18. 18.
    Ali MJ, Baig F, Lakshman M, Naik MN (2015) Electron microscopic features of nasal mucosa treated with topical and circumostial injection of mitomycin C: implications in dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 31(2):103–107CrossRefGoogle Scholar
  19. 19.
    Ali MJ, Mariappan I, Maddileti S, Ali MH, Naik MN (2013) Mitomycin C in dacryocystorhinostomy: the search for the right concentration and duration: a fundamental study on human nasal mucosa fibroblasts. Ophthalmic Plast Reconstr Surg 29(6):469–474CrossRefGoogle Scholar
  20. 20.
    Kao SC, Liao CL, Tseng JH et al (1997) Dacryocystorhinostomy with intraoperative mitomycin C. Ophthalmology 104:86–91PubMedCrossRefGoogle Scholar
  21. 21.
    Yeatts RP, Neves RB (1999) Use of mitomycin C in repeat dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 15(1):19–22CrossRefGoogle Scholar
  22. 22.
    Camara JG, Bengzon AU, Henson RD (2000) The safety and efficacy of mitomycin C in endonasal endoscopic laser-assisted dacryocystorhinostomy. Ophthalmic Plast Reconstr Surg 16(2):114–118CrossRefGoogle Scholar
  23. 23.
    Dolmetsch AM, Gallon MA, Holds JB (2008) Nonlaser endoscopic endonasal dacryocystorhinostomy with adjunctive mitomycin C in children. Ophthalmic Plast Reconstr Surg 24:390–393CrossRefGoogle Scholar
  24. 24.
    Kamal S, Ali MJ, Naik MN (2014) Circumostial injection of mitomycin C (COS-MMC) in external and endoscopic dacryocystorhinostomy: efficacy, safety profile, and outcomes. Ophthalmic Plast Reconstr Surg 30(2):187–190CrossRefGoogle Scholar
  25. 25.
    Leibovitch I, Prabhakaran VC, Davis G, Selva D (2007) Intraorbital injection of triamcinolone acetonide in patients with idiopathic orbital inflammation. Arch Ophthalmol 125(12):1647–1651PubMedCrossRefGoogle Scholar
  26. 26.
    Ebner R, Devoto MH, Weil D et al (2004) Treatment of thyroid associated ophthalmopathy with periocular injections of triamcinolone. Br J Ophthalmol 88(11):1380–1386PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Kalina PH, Erie JC, Rosenbaum L (1995) Biochemical quantification of triamcinolone in subconjunctival depots. Arch Ophthalmol 113(7):867–869PubMedCrossRefGoogle Scholar
  28. 28.
    Woo KI, Maeng HS, Kim YD (2011) Characteristics of intranasal structures for endonasal dacryocystorhinostomy in asians. Am J Ophthalmol 152(3):491–498PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Emmy Y. Li
    • 1
  • Andy C. Cheng
    • 1
  • Alex C. Wong
    • 1
  • Amy M. Sze
    • 1
  • Hunter K. Yuen
    • 1
  1. 1.Department of Ophthalmology & Visual Sciences, University Eye Center, 3/F, Hong Kong Eye HospitalThe Chinese University of Hong KongHong Kong SARChina

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