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Dacryocystorhinostomy: An age-old but still relevant approach to tearing
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KOLOA, Hawaii — Dacryocystorhinostomy, a procedure that bypasses a blocked nasolacrimal duct, is a dated procedure but still a relevant one, according to a speaker here.
“DCR is an old procedure,” Jeremiah Tao, MD, said at Hawaiian Eye 2017, citing the procedure as being thousands of years old while also citing success rates of 90% to 95% for external approaches and 80% to 90% for internal approaches.
Jeremiah Tao
There is room for improvement, however, particularly in the areas of the wounds, both functionally and aesthetically for both external and internal scars, he said.
“In achieving these improvements, it’s important to talk about the osteotomy. The osteotomy drives the rest of the procedure,” Tao said. “I actually like to create a larger osteotomy than is in most descriptions. A larger osteotomy gives us an opportunity to achieve something different for anatomical reconfiguration.”
Using the larger osteotomy in the external approach yields better internal wound control, according to Tao, although there are areas where caution is needed. The medial canthus anatomy includes angular vessels, the medial canthal tendon and the buccal branch of the facial nerve, which, if damaged, can lead to the “most feared complication” — the eyelid becoming paretic.
Achieving a good aesthetic result after DCR is done using “one of the core principles of camouflage,” Tao said, wherein surgeons “keep the incisions in the grain,” or in the relaxed skin tension lines. This could entail using horizontal rather than vertical incisions or using Z- or W-shaped incisions. – by Patricia Nale, ELS
Reference:
Tao JP. Tearing from lacrimal system pathology: How to fix the plumbing. Presented at: Hawaiian Eye; Jan. 14-20, 2017; Koloa, Hawaii.
Disclosure: Tao reports no relevant financial disclosures.