1. VELEMEGNA GOOD NEWS SOCIETY-BIDAR,KARNATAKA
DR SALINS EYE HOSPITAL
VELEMEGNA GOOD NEWS SOCIETY-BIDAR,KARNATAKA

2. Successful external DCR- Factors to be considered
Dr Sybil Meshramkar
Dr Praveen Sadanand

3. External DCR – gold standard for NLDO compared to endonasal or transcanalicular DCR
Aim – consider factors affecting success of DCR
Inclusion criteria – chr.dacryocystitis, mucocele, epiphora.
Exclusion criteria - < 10yrs, nasal pathology, lid laxity, canalicular obstruction.

4. Lacrimal drainage disorders
Chronic dacryocystitis (59)
Lacrimal fistula (1)
Mucocele (1)
Previous failed DCR(1)

5. Discharge in eyes

6. Age and sex distribution
males
No. of patients
<40yrs 1
40yrs-85yrs 6
females 15 40
Total 62

7. Surgical procedure Large osteotomy Suturing of anterior flaps
Silicon tube intubation

8. Anterior Nasal Mucosal Flap

9. Sac Mucosal Flap

10. Silicon Intubation Tube

11. Silicon Tube Knotted

12. Knotted Silicon Tube Outside The External Nares

13. Nasal and Sac Mucosal Sutured

14. Silicon Intubation Tube Seen In The Puncta

15. Intraoperative complications
Bleeding from incision site 2
Bleeding from nasal mucosa 8
Inappropriate place and size of osteotomy
Difficulty fashioning the mucosal flaps 1

16. Intraoperative bleeding
% of cases
study
27.5%
Mirzaman etal
13%
Adravani etal
6.2%
Gazemund K
0.6%
Akhund
16.2%
Present study

17. Late postoperative complications
scar 4
Conjunctival irritation by tube 2
Non patency 1
Punctal/canalicular tear

18. Post operative complications
Scar very faint - acceptance
complications like migration of tube, rupture of central thinner segment, slitting of punctum – not found.

19. Postoperative results
patent
Non patent
At 6 months (silicon tube removed ) 61 1
At 1 year

20. Intubation tube in left eye
98% success
Success – resolution of symptoms like epiphora and discharge & a patent lacrimal system on irrigation.
Silicon intubation facilitates epithelialization of DCR fistula.
Intubation tube in left eye

21. Success rates with silicon intubation
% of success
Study conducted
97.5%
Mirzaman etal
95%
Tarbat etal
98.14%
Talpur etal
Advani etal
96%
Besharati MR etal
98%
Present study

22. Conclusion Meticulous surgery and proper identification of structures.
Big osteotomy esp, younger patients.
Silicon tube intubation in all.
Tight opposition of anterior flaps.

23. Thank You