Usman Ahmed, Akmal Khan, Humayun Agha, Amna Usman.
External Dacryocystorhinostomy or Endoscopic Endonasal Dacryocystorhinostomy, Results of Surgery with Multi-disciplinary Team Approach.
Ophthalmol Update Jan ;16(2):613-6.

Objective of study was to evaluate the results of external Dacryocystorhinostomy (Ext DCR) with endoscopic endonasal dacryocystorhinostomy (End DCR), through multidisciplinary team (Eye and ENT Surgeon). The study was done in POF Hospital, Wah Cantt between 1st May2007 and 1st May 2017. Method: It was a purposive multidisciplinary approach combining Eye surgeons and ENT Surgeon applied, to decide whether patient require external DCR or Endo nasal DCR. Patient with nasal pathology or nasal anomaly and cosmetic concern were selected for End DCR while others had Ext DCR. Failure or success of surgery depended on free flow of saline from both upper and lower puncta and relief of major symptom that was epiphora after 3 months and 6 months follow-up, after 3 months and 6 months follow-up. Results. Results were analyzed using SPSS. 80 patients had external DCR while 175 had endoscopic endonasal DCR. 3/80 (3.75%) patients with external DCR had a failure of surgery depicted by difficulty in free flow of saline on irrigation and epiphora. In endoscopic DCR 9/175 (5.14) had failure of surgery. Overall success rate of external versus endonasal endoscopic DCR was 96.25% to 94.85% respectively. In External DCR series, cause of failure was deviated nasal septum (DNS) in 2 cases and 1 case had stenosis of ostium. In End DCR series 6 cases failed due to stenosis of ostium while 3 failed because of technical fault as ostium was made in the lower part of nasolacrimal duct. Conclusion: DCR surgery when done as a multidisciplinary approach with careful selection of patient gives better results. In our study ophthalmologist and ENT surgeon was more comfortable utilizing this approach, the results of surgery whether external or endoscopic was also comparable.

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