Advertisement

Revision Dacryocystorhinostomy

  • Emmy Y. Li
Chapter

Abstract

Dacryocystorhinostomy (DCR) is performed to relieve nasolacrimal duct obstructions that cause epiphora or dacryocystitis. With the advances in instruments and techniques, both external (EXT-DCR) and endonasal endoscopic DCR (EN-DCR) achieve relatively high success rates with minimal complications. In cases of failure, the common causes include inadequately sized or inappropriately placed osteotomy or sac opening, scarring or granulation tissue at the ostium, and common canalicular obstruction. Management of failed DCR is mainly surgical, although some patients may opt for observation. Revision via either endoscopic or external approach achieves relatively high success rates with outcomes slightly more favorable for EN-DCR. Laser-assisted revision EN-DCR is a less traumatic alternative, particularly useful for membranous obstruction at the internal ostium. It is proven that adjunctive mitomycin-C (MMC) can help to enhance the success of revision cases. Silicone tube placement may be considered, especially in the presence of common canalicular obstruction. Balloon dacryoplasty, in highly selected patients, can also achieve good results. Appropriate assessment to identify the cause of DCR failure is essential to determine the preferred surgical approach for revision and to optimize the clinical outcome.

Keywords

Dacryocystorhinostomy Revision dacryocystorhinostomy Nasolacrimal duct obstruction Endonasal Endoscopic revision Ostium fibrosis Mitomycin Dacryoplasty Silicone intubation Sump 

References

  1. 1.
    Toti A. Nuovo metodo conservatore di cura radicale delle suppurazioni croniche de1 sacco lacrimale (Dacriocistorinostomia). Clin Mod Firenze. 1904;10:385–7.Google Scholar
  2. 2.
    Woog JJ, Kennedy RH, Custer PL, Kaltreider SA, Meyer DR, Camara JG. Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2001;108:2369–77.PubMedCrossRefGoogle Scholar
  3. 3.
    Huang J, Malek J, Chin D, Snidvongs K, Wilcsek G, Tumuluri K, Sacks R, Harvey RJ. Systematic review and meta-analysis on outcomes for endoscopic versus external dacryocystorhinostomy. Orbit. 2014;33(2):81–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Welham RA, Wulc AE. Management of unsuccessful lacrimal surgery. Br J Ophthalmol. 1987;71(2):152–7.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Hull S, Lalchan SA, Olver JM. Success Rates in powered endonasal revision surgery for failed dacryocystorhinostomy in a tertiary referral center. Ophthal Plast Reconstr Surg. 2013;29:267–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Mauriello JA Jr, Vahedra V, Fleckner M, Shah C. Correlation of orbital computed tomographic findings with office probing and irrigation in 17 patients after successful and failed dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 1999;15(2):116–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Konuk O, Kurtulmusoglu M, Knatova Z, Unal M. Unsuccessful lacrimal surgery: causative factors and results of surgical management in a tertiary referral center. Ophthalmologica. 2010;224(6):361–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Gupta N. Improving results in endoscopic DCR. Indian J Otolaryngol Head Neck Surg. 2011;63(1):40–4.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Hammoudi DS, Tucker NA. Factors associated with outcome of endonasal dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2011;27(4):266–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Garcia Vilaro M, Vásquez L, Marin A, Burés A, Medel R. Thermal damage influences endonasal dacryocystorhinostomy success. Ophthalmic Res. 2013;49(4):209–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Mak ST, Io IY, Wong AC. Prognostic factors for outcome of endoscopic dacryocystorhinostomy in patients with primary acquired nasolacrimal duct obstruction. Graefes Arch Clin Exp Ophthalmol. 2013;251:1361–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Fayers T, Laverde T, Tay E, Olver JM. Lacrimal surgery success after external dacryocystorhinostomy: functional and anatomical results using strict outcome criteria. Ophthal Plast Reconstr Surg. 2009;25(6):472–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Dietrich C, Mewes T, Kühnemund M, et al. Long-term follow-up of patients with microscopic endonasal dacryocystorhinostomy. Am J Rhinol. 2003;17:57–61.PubMedCrossRefGoogle Scholar
  14. 14.
    Zenk J, Karatzanis AD, Psychogios G, et al. Long-term results of endonasal dacryocystorhinostomy. Eur Arch Otorhinolaryngol. 2009;266:1733–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Chan W, Selva D. Ostium shrinkage after endoscopic dacryocystorhinostomy. Ophthalmology. 2013;120:1693–6.PubMedCrossRefGoogle Scholar
  16. 16.
    McLachlan DL, Shannon GM, Flanagan JC. Results of dacryocystorhinostomy: analysis of the reoperations. Ophthalmic Surg. 1980;11(7):427–30.PubMedGoogle Scholar
  17. 17.
    McMurray CJ, McNab AA, Selva D. Late failure of dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2011;27(2):99–101.PubMedCrossRefGoogle Scholar
  18. 18.
    Wormald PJ, Tsirbas A. Investigation and endoscopic treatment for functional and anatomical obstruction of the nasolacrimal duct system. Clin Otolaryngol Allied Sci. 2004;29:352–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Mansour K, Blanksma LJ, Vrakking H, et al. Scintigraphic evaluation for tear drainage, after dacryocystorhinostomy, in relation to patient satisfaction. Eye. 2008;22:414–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Brewis C, Yung M, Merkonidis C, et al. Endoscopic dacryocystorhinostomy in functional lacrimal obstruction. J Laryngol Otol. 2007;27:1–3.Google Scholar
  21. 21.
    Gökçek A, Argin MA, Altintas AK. Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings. Eur J Ophthalmol. 2005;15(5):523–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Takahashi Y, Nakamura Y, Kakizaki H. Dacryoendoscopic findings in the lacrimal passage in failed dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2013;29(5):373–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Tsirbas A, Davis G, Wormald PJ. Revision dacryocystorhinostomy: a comparison of endoscopic and external techniques. Am J Rhinol. 2005;19(3):322–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Orcutt JC, Hillel A, Weymuller EA. Endoscopic repair of failed dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 1990;6:197–202.PubMedCrossRefGoogle Scholar
  25. 25.
    El-Guindy A, Dorgham A, Ghoraba M. Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol. 2000;109(4):425–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Demarco R, Strose A, Araújo M, et al. Endoscopic revision of external dacryocystorhinostomy. Otolaryngol Head Neck Surg. 2007;137:497–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Ramakrishnan VR, Durairaj VD, Kingdom TT. Revision endoscopic dacryocystorhinostomy. Oper Tech Otolaryngol. 2008;19(3):177–81.CrossRefGoogle Scholar
  28. 28.
    Rose GE, Walland MJ. Factors affecting the success rate of open lacrimal surgery. Br J Ophthalmol. 1994;78:888–91.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Paik JS, Cho WK, Yang SW. Comparison of endoscopic revision for failed primary external versus endoscopic dacryocystorhinostomy. Clin Exp Ophthalmol. 2013;41(2):116–21.PubMedCrossRefGoogle Scholar
  30. 30.
    Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology. 2005;112(8):1463–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Lee J, Choi SY, Lee H, Chang M, Park M, Baek S. The clinical effectiveness of transcanalicular diode laser-assisted revision surgery for failed endoscopic endonasal dacryocystorhinostomy. Br J Ophthalmol. 2015;99(8):1130–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Patel BCK, Phillips B, McLeish WM, et al. Transcanalicular neodynium: YAG laser for revision of dacryocystorhinostomy. Ophthalmology. 1997;104:1191–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Ugurbas SH, Zilelioglu G, Sargon MF, Anadolu Y, Akiner M, Aktürk T. Histopathologic effects of mitomycin-C on endoscopic transnasal dacryocystorhinostomy. Ophthalmic Surg Lasers. 1997;28(4):300–4.PubMedGoogle Scholar
  34. 34.
    Xue K, Mellington FE, Norris JH. Meta-analysis of the adjunctive use of mitomycin C in primary and revision, external and endonasal dacryocystorhinostomy. Orbit. 2014;33(4):239–44.PubMedCrossRefGoogle Scholar
  35. 35.
    Ozkiriş M, Ozkiriş A, Göktaş S. Effect of mitomycin C on revision endoscopic dacryocystorhinostomy. J Craniofac Surg. 2012;23(6):e608–10.PubMedCrossRefGoogle Scholar
  36. 36.
    Penttilä E, Smirnov G, Seppä J, Kaarniranta K, Tuomilehto H. Mitomycin C in revision endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol Allergy. 2011;25(6):425–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Unlu HH, Toprak B, Aslan A, et al. Comparison of surgical outcomes in primary endoscopic dacryocystorhinostomy with and without silicone intubation. Ann Otol Rhinol Laryngol. 2002;111:704–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Woog JJ, Kennedy RH, Custer PL, et al. Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2001;108:2369–77.PubMedCrossRefGoogle Scholar
  39. 39.
    Chong KK, Lai FH, Ho M, Luk A, Wong BW, Young A. Randomized trial on silicone intubation in endoscopic mechanical dacryocystorhinostomy (SEND) for primary nasolacrimal duct obstruction. Ophthalmology. 2013;120(10):2139–45.PubMedCrossRefGoogle Scholar
  40. 40.
    Smirnov G, Tuomilehto H, Teräsvirta M, Nuutinen J, Seppä J. Silicone tubing after endoscopic dacryocystorhinostomy: is it necessary? Am J Rhinol. 2006;20(6):600–2.PubMedCrossRefGoogle Scholar
  41. 41.
    Maheshwari R. Balloon catheter dilation for complex congenital nasolacrimal duct obstruction in older children. J Pediatr Ophthalmol Strabismus. 2009;46(4):215–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Couch SM, White WL. Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction. Ophthalmology. 2004;111(3):585–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Lee A, Ali MJ, Li EY, Wong AC, Yuen HK. Balloon dacryoplasty in internal ostium stenosis after endoscopic dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2014;30(1):7–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Emmy Y. Li
    • 1
  1. 1.Department of OphthalmologyHong Kong Eye HospitalKowloon CityHong Kong

Personalised recommendations