A U-SHAPED MUCOSAL INCISION OUTCOME VERSUS H-SHAPED IN THE EXTERNAL DACRYOCYSTORRHINOSTOMY PROCEDURE
Abdulrahman Hama Amin Hussein a, Sakar Abdulkarim Nidhamalddin b, and Sanoor Qader Mahmood b
a Shahid Dr. Aso Teaching Eye Hospital.
b Shahid Dr. Aso Teaching Eye Hospital.
Submitted: 19/3/2019; Accepted: 29/7/2019; Published: 21/9/2019
DOI Link: https://doi.org/10.17656/jsmc.10209
Despite the long-time passed since the beginning of using dacryocystorhinostomy (DCR) for the treatment of nasolacrimal duct obstruction, it still has the highest success rate among the other surgical procedures used for the treatment of the same condition that is why it is still widely accepted and used procedure.
To evaluate the outcome of External-DCR by using manipulated surgical technique in creating anterior flap without posterior flap.
Patients and Methods
A retrospective review of patients who underwent External DCR between Sep. 2012 to Feb. 2014 at Shahid Dr. Aso Teaching Eye hospital in Sulaimani city which was performed by a single surgeon. The data of 65 patients were analyzed, all with the chief complaint of watering eye and mucocele. A U-shaped manner mucosal incision was done to create enough size anterior flap without posterior flap, after follow-up of about two years’, postoperative success was defined objectively by irrigation of the puncta without regurgitation and subjectively by patient satisfaction with the absence of epiphora or mucocele. Ethical consideration of the risks and benefits of the procedure was observed for each individual patient.
A 69 External-DCR were performed on 65 patients, of which 53 were female and 12 were males between the age of 17 and 64, all with the complaint of watering eye and mucocele. After follow up period of two years the overall success rate was 96.9%. Each individual factor like age, sex, IOP and presence of other ocular conditions were assessed against the outcome in all of them, the correlation was not significant (value > 0.05) in all instances. That makes the procedure employed the sole factor in this high success rate of the outcome.
Creating only anterior anastomosis is technically simpler, easier, less time consuming and does not negatively influence the outcome of External-DCR surgery, this procedure demonstrates higher success rate comparable to that of the conventional method in the literature, so we conclude that the procedure can be implemented as a standard technique for external DCR.
External DCR, Anterior flap, Mucocele.
1. Yanoff M, Duker JS. 3rd ed. Philadelphia: Mosby Elsevier; 2009. [Last accessed on 2013 Jun 14]. Ophthalmology; pp. 1482–7. Available from:
2. Duggal P, Chakravorty S, Azad RK, Mohan C. An epidemiological study on patients undergoing dacryocystorhinostomy. Indian J Otolaryngol Head Neck Surg. 2006; 58:349–51.
3. Older JJ. Routine use of a silicone stent in a dacryocystorhinostomy. 1982; 13:911-915
4. 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. 2005; 112:1463-1468
5.PJ. Comparison of external dacryocystorhinostomy with nonlaser endonasal 5. Dolman dacryocys-torhinostomy. 2003;
6. Piaton JM, Limon S, Ounnas N, Keller P. Transcanalicular endodacryocystorhinostomy using Neodymium: YAG laser. 1994; 17:555-567
7. Burns JA, Cahill KV. Modified Kinosian dacryocystorhinostomy: a review of 122 cases. 1985; 16:710-716
8. Toti A. Nouvo metodo conservatore di cura radicale delle suppurazioni croniche del sacco lacrimale (dacriocistorinostomia). Clin Moderna Firenze. 1904; 10: 385-7.
9. Dupuy-Dutemps L, Bourguet M. Procede plastique de dacryocystorhinostomie et ses results. Ann Ocul. 1921; 158: 241-61.
10. Yang JW, Oh HN. Success rate and complications of endonasal dacryocystorhinostomy with unciformectomy. Graefes Arch Clin Exp Ophthalmol. 2012; 250:1509–
11. KneĚević MM, Vlajković GP, Stojković MŽ, Rašić DM, Stanković BR, BoĚić MM. Comparison of postoperative pain and satisfaction after dacryocystorhinostomy in patients operated on under local and general anesthesia. Med Sci Monit. 2012;18:CR265–70. ]
12. Gilliland G. Dacryocystitis. In: Agarwal S, Agarwal A, Apple DJ, Buratto L, Alio JL, Pandey SK, et al., editors. Textbook of Ophthalmology. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2002. pp. 705–12.
13. Yoon SW, Yoon YS, Lee SH. Clinical results of endoscopic dacryocystorhinostomy using a microdebrider. Korean J Ophthalmol. 2006; 20:1–6.
14. Babar TF, Masud MZ, Saeed N, Khan MD. An analysis of patients with chronic dacryocystitis. Pak J Ophthalmol. 2003; 19:77–83.
15. Ivaniševic M, Bojic L, Lešin M, Žuljan I, Bucan K, Kovacic Ž. Primary acquired nasolacrimal duct obstruction: Epidemiological analysis of 91 patients. Med JAD. 2007; 37:37–41.
16. Komínek P, Matoušek P, Štrympl P. Dacryocystitis as the first symptom of sinonasal carcinoma. Ophthalmology. 2010; 24:343–5.
17. Singh M, Jain V, Singh SP, Gupta SC. Endoscopic dacryocystorhinostomy in cases of dacryocystitis due to atrophic rhinitis. J Laryngol Otol. 2004; 118:426–8.
18 .Yazici B, Yazici Z. Final nasolacrimal ostium after external dacryocystorhinostomy. 2003; 121:76-80
19. Kaçaniku G, Spahiu K. Anterior Flaps Anastomosis in External Dacryocystorhinostomy. Medical Archives [Internet]. 2011;(65). Available from: https://www.ejmanager.com/mnstemps/10/10-1301258919.pdf
20. Benawie K, Ali N, Elias N. Anterior single flap external dacryocystorhinostomy: outcome in 200 Sudanese patients. International Journal of ophthalmology [Internet]. 2019Jun18;2(2):162–4. Available from: http://www.ijo.cn/en_publish/2009/2/200902015.pdf
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.