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      Dacriocistorrinostomía externa, conjuntivo-dacriocistorrinostomía y cirugía de la vía lagrimal en el meato inferior Translated title: External dacryocystorhinostomy, conjunctivo-dacryocystorhinostomy and Inferior nasal meatus lacrimal surgery

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          Abstract

          RESUMEN Introducción y objetivo: Realizar una revisión sobre la dacriocistorrinostomia externa (DCR-ext), conjuntivo dacriocistorrinostomía (CDCR) y cirugía lagrimal en del meato inferior (sondaje de la vía lagrimal), empleadas ante la presencia de una obstrucción de la vía lagrimal. Material y métodos: revisión bibliográfica sobre técnicas quirúrgicas mencionadas. Discusión: La obstrucción de la vía lagrimal puede dividirse según su localización en proximales y distales. Ante obstrucciones distales, la DCR ext es la técnica gold estándar con porcentajes de éxito superiores al 95% y la CDCR en el caso de obstrucciones proximales. El sondaje de la vía lagrimal es la principal indicación quirúrgica en obstrucción congénita.

          Translated abstract

          SUMMARY Introduction and objective: To carry out an update review on external dacryocystorhinostomy(ext-DCR), conjunctivo dacryocystorhinostomy (C-DCR) and inferior nasal meatus lacrimal surgery (lacrimal probing) to treat lacrimal system obstructions. Method: Review of published literature regarding surgical treatment mentioned. Discussion: Depending on the location, nasolacrimal obstructions may be proximal or distal. External dacryocystorhinostomy is the gold standard technique, with success rates over 95%, to treat distal obstructions, and conjunctivo -dacryocystorhinostomy to proximal ones. In case of congenital duct obstructions probing will be the first surgical treatment prescribed.

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          External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost.

          K Tarbet, R P Custer (1995)
          External dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, with success rates consistently above 90%. This study reviews the demographics, success, cost, efficiency, and patient satisfaction in external DCR. This information will be useful as comparison criteria for evaluating new surgical techniques. Records of 169 external DCR procedures performed over an 8.7-year period were reviewed. All patients had preoperative symptoms of tearing and/or dacryocystitis with a component of nasolacrimal obstruction. Patient demographics, history, examination findings, surgical and anesthesia information, postoperative success, complications, and follow-up course were recorded. Patient satisfaction and long-term success were evaluated by telephone survey. External DCR often required middle turbinectomy (17%), exposure of ethmoid sinuses (17%), and removal of dacryoliths (14%). Most patients (90%) underwent silicone intubation, with the tubes removed at an average of 3.7 weeks after surgery. A patent system was established in 95% of procedures, whereas 92% remained asymptomatic. Postoperative complications included hemorrhage (3.9%) and scarring (2.6%). Of the surveyed patients, 87% denied continued or recurrent symptoms; 97% rated their incision "good" to "excellent" in appearance; and all patients stated they would recommend the procedure to others. External DCR is highly successful, requires limited follow-up, and is a cost-effective procedure. Complications are uncommon, and patient satisfaction is high. New lacrimal surgical techniques must be evaluated against the long-proven success of the external approach.
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            Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure?

            M Kashkouli, A Kassaee, M M Parvaresh … (2003)
            To find the cure rate of late (second year of age) and very late (3-5 years of age) initial probing for congenital nasolacrimal duct obstruction (CNLDO) and to identify the factors contributing to the failure rate of the probing in older children. In a prospective interventional case series study, 169 eyes of 125 consecutive patients (1-5 years old) with CNLDO underwent probing under general anaesthesia. Cure was defined as absence of tearing and discharge in the affected eye. 138 eyes of 101 patients aged 13-60 months (mean 23.4 (SD 10.2)) were included. Of 15 eyes (10.8%) with complex CNLDO, 80% presented after 24 months of age (p<0.0001). The cure rate was 89% in patients 13-24 months of age and 72% after the age of 24 months (p = 0.01). It was 90.2% in the membranous and 33.3% in the complex CNLDO in both late and very late probing (p<0.0001). There was a high correlation (r = 0.97) and no significant difference between the cure rate at 1 week and final follow up. Accumulation of the complex CNLDO is the main risk factor for failure of probing in the older children. The outcome of the nasolacrimal duct probing at 1 week follow up is highly indicative of the final outcome.
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              Outcome of probing for congenital nasolacrimal duct obstruction in older children.

              Santosh Honavar, Vasudha E Prakash, Gullapalli N. Rao (2000)
              To evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome. The study was a single-center, prospective, interventional case series. Sixty patients with congenital nasolacrimal duct obstruction aged 24 months or older (range, 24 to 186 months; median, 33 months) presenting consecutively to the authors' institutional referral practice were studied. Probing of the nasolacrimal system under general anesthesia was the surgical intervention. Success of probing was the main outcome measure. Success was predefined as complete resolution of symptoms and signs (tearing, crusting, discharge, regurgitation on pressure over the lacrimal sac) of congenital nasolacrimal duct obstruction within 3 weeks of the procedure and continued remission at 6 months. Two attempts at probing were necessary before the procedure was declared a failure. One attempt at probing resulted in resolution in 73.3% (44 of 60) patients. Sixteen patients needed a repeat procedure. The overall success rate was 80% (48 of 60). Two specific types of obstructions of the nasolacrimal duct were recognized on probing: membranous and firm. Factors predictive of failure of probing were age older than 36 months (P <.0001); bilateral affection (P =.012); failed conservative therapy (P =.015); failed earlier probing (P <.0001); dilated lacrimal sac (P <.0001); and firm obstruction (P <.0001). Results indicate that probing is a viable primary surgical option for congenital nasolacrimal duct obstruction in children who present between 2 and 3 years of age, and identify factors predictive of poor prognosis.
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                Author and article information

                Journal
                Journal ID (publisher-id): orl
                Title: Revista ORL
                Abbreviated Title: Rev. ORL
                Publisher: Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                ISSN (Electronic): 2444-7986
                Publication date (Print and electronic): June 2021
                Volume: 12
                Issue: 2
                Pages: 79-91
                Affiliations
                [1] Valladolid orgnameHospital Universitario Río Hortega orgdiv1Servicio Oftalmología orgdiv2Unidad de Órbita, Oculoplástica y Vías Lagrimales España
                [2] Valladolid orgnameHospital Universitario Río Hortega orgdiv1Servicio Otorrinolaringología España
                Article
                Publisher ID: S2444-79862021000200008 Publisher ID: S2444-7986(21)01200200008
                DOI: 10.14201/orl.24154
                SO-VID: 83d56a38-4d41-4da8-b710-878af6e8a40e
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Date received : 01 October 2020
                Date accepted : 04 December 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 65, Pages: 13
                Product

                SciELO Spain

                Categories
                Subject: Artículo de revisión

                Keywords: External dacryocystorhinostomy,sondaje nasolagrimal,conjuntivodacriocistorrinostomia,Dacriocistorrinostomia externa,conjunctivo-dacryocystorhinostomy,nasolacrimal probing
                Data availability:
                Keywords: External dacryocystorhinostomy, sondaje nasolagrimal, conjuntivodacriocistorrinostomia, Dacriocistorrinostomia externa, conjunctivo-dacryocystorhinostomy, nasolacrimal probing

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