Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




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"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Believers Church Medical College,
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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
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Best regards,
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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 182 - 186

External Dacryocystorhinostomy Versus Endoscopic Dacryocystorhinostomy: A Comparison

KULDEEP MORAS MAHESH BHAT SHREYAS C S NORMAN MENDONCA GEORGE PINTO

Department of Otorhinolaryngology, Ophthalmology Fr. Muller Medical college, Mangalore.

Correspondence Address :
Dr. Kuldeep Moras,
Asst. Professor, Department of Otorhinolaryngology,
Fr. Muller Medical college, Kankanady,
Mangalore- 575002
E-mail: kuldeepmoras@gmail.com
Mobile No.: +91 9902200638

Abstract

Toti’s technique of external dacryocystorhinostomy (DCR) had been the treatment of choice for epiphora due to nasolacrimal duct obstruction since 1904. With the introduction of rigid nasal endoscopes in the 1970s and the advent of endoscopic sinus surgery, intranasal endoscopic dacryocystorhinostomy has come into existence. This study compares the outcome of external dacryocystorhinostomy with endoscopic endonasal dacryocystorhinostomy. 40 patients who were diagnosed with primary acquired nasolacrimal duct obstruction or chronic dacryocystitis were included in the study. They were randomized into two groups. Group I included 20 patients who underwent external dacryocystorhinostomy and group II included the rest of the 20 patients who underwent endoscopic endonasal dacryocystorhinostomy. Although both the procedures had a success rate of 90%, endoscopic DCR was helpful in avoiding a scar on the face and injury to the neighbouring structures like the medial palpebral ligament and the angular facial vessels. The surgical duration for endoscopic DCR was short as compared to that of the external approach. Our study concludes that endoscopic DCR is as good as external DCR for the treatment of primary nasolacrimal duct obstruction and chronic dacryocystitis.

Keywords

Endoscopic dacryocystorhinostomy, external dacryocystorhinostomy.

How to cite this article :

KULDEEP MORAS MAHESH BHAT SHREYAS C S NORMAN MENDONCA GEORGE PINTO . EXTERNAL DACRYOCYSTORHINOSTOMY VERSUS ENDOSCOPIC DACRYOCYSTORHINOSTOMY: A COMPARISON. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Apr 21 ]; 5:182-186. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=182-186&id=1237

Introduction Chronic dacryocystitis is defined as the chronic inflammation of the lacrimal sac due to stricture of the nasolacrimal duct secondary to chronic inflammation, usually nasal in origin. The essential symptom is epiphora, which is aggravated by conditions such as exposure to wind. There may be swelling at the site of the sac (mucocele), and the neighbouring parts of the conjuctiva are frequently inflamed. On applying pressure over the sac, mucopus or sometimes frank pus regurgitates through the puncta. The bacteriological study of the fluid demonstrates the presence of a number of bacteria, both aerobic and anaerobic. The diagnostic procedures include lacrimal probing, lacrimal irrigation, dacryocystography, the jones dye test, the fluorescein test and radionuclear cystography. Appropriate clinical and radiographical testing when indicated, will aid in the diagnosis of dacryocystitis. For over a century, the gold standard of treatment for epiphora due to nasolacrimal duct obstruction has been dacryocystorhinostomy. It was Toti, who in 1904, reported this procedure for external dacryocystorhinostomy. He made a hole in the lacrimal sac and another hole in the nose and approximated the two with a tight pressure bandage.(1) This operation has got refined over the years into the present day external dacryocystorhinostomy. Since the time of Toti, the only major advance in the technique has been the use of a sialastic tubing.

Endonasal dacryocystorhinostomy procedures were first described in 1893 by Caldwell, in which a portion of the inferior turbinate was removed and the nasolacrimal duct was followed till the lacrimal sac1.

With the advent of rigid nasal endoscopes in the 1970s, the intranasal endoscopic approach to the lacrimal sac was feasible. A cadaveric study demonstrating endoscopic intranasaldacryocystorhinostomy was reported by Rice in 1988, followed by a review of 4 patients in 1990.(2) The first clinical study on endoscopic intranasal dacryocystorhinostomy was published by Mc Donagh and Meiring in 1989.(3)

Many variations of endoscopic dacryocystorhinostomy with little modificationslike the use of stents, laser and mitomycin-C have been described in the last decade, withequally good results. Although Toti’s operation of external dacryocystorhinostomy has in good hands, a success rate of about 90%, endoscopic dacryocystohinostomy is gaining popularity as there is no facial scar and no disruption of the medial palpebral ligament or the angular facial vessels.

This study compares the outcome of external dacryocystorhinostomy with that of endoscopic endonasal dacryocystorhinostomy.

AIMS OF THE STUDY

(1). To study the outcome of external dacryocystorhinostomy. (2). To study the outcome of endoscopic endonasal dacryocystorhinostomy. (3). To compare the outcome of external dacryocystorhinostomy with that of endoscopic endonasal dacryocystorhinostomy

Material and Methods

The Present Study: “External dacryocystorhinostomy versus endoscopic endonasal dacryocystorhinostomy: A Comparison”, was conducted in the Department of Otorhinolaryngology, Fr. Muller Medical College Hospital, Mangalore. Source of data: The patients attending the opthalmology and the ENT out patient departments of Fr. Muller Medical College Hospital, Mangalore, who were diagnosed for primary acquirednasolacrimal duct obstruction or chronic dacryocystis by an opthalmologist. Sample Size: The study included 40 cases who were diagnosed with primary acquired nasolacrimal duct obstruction or chronic dacryocystitis. They were randomized into two groups. Group I included 20 patients who underwent external dacryocystorhinostomy and group II included the rest of the 20 patients who underwent endoscopic endonasal dacryocystorhinostomy.

Inclusion Criteria:1) All symptomatic cases of epiphora which were diagnosed for primary acquired nasolacrimal duct obstruction or chronic dacryocystitis. 2) Those who were willing to undergo surgery.

Exclusion Criteria: Cases with canalicular and punctal obstruction. . Cases with ectropion or entropion. (3). Cases with noticeable lower lid laxity.

A detailed history was taken. A thorough anterior rhinoscopy was done and any abnormalities like a deviated nasal septum, polyposis and hypertrophied turbinates were looked for. The opthalmic examination was done by an opthalmologist. The eyelids were examined for entropion, ectropion and lid laxity. The puncti were examined for their normal location and size. Any medial canthal swelling was noted. Nasolacrimal duct obstruction was diagnosed by the regurgitation of fluid into the conjunctival sac by applying pressure over the lacrimal sac area. Lacrimal sac syringing was done to confirm the diagnosis. Routine blood investigations were also done.

All external dacryocystorhinostomy operations were performed under local anaesthesia.
After anaesthetizing the nasal mucosa with a 10% xylocaine spray, the nasal cavity was packed with a roller gauze which was soaked in 4% xylocaine with adrenaline 1:10,000. All patients were given local anaesthesia for the sac region, consisting of 2% xylocaine with adrenaline 1:2,00,000. A curvilinear incision, 1.5 to 2cms in length, was made lateral to the angular vein, 3mm from the medial canthus. The orbicularis muscle fibers were separated. The lacrimal fascia was incised 1mm lateral to the anterior lacrimal crest and the bony attachment of the medial canthal ligament was divided. The lacrimal sac was separated from the lacrimal fossa. The lamina papyracae, the papery thin bone of the posterior half of the lacrimal fossa was fractured and the nasal mucosa was stripped from the lacrimal bone to avoid damage to it. A bony osteotomy, approximately 10mm in diameter, was created. Oozing of the blood was controlled by packing with ribbon gauze which was moistened with 2% xylocaine with adrenaline.
After anaesthetizing the eye with 4% xylocaine drops, the upper punctum was dilated and a Bowman’s probe was passed through it to tent the medial sac wall. With a 11 No. Bard Parker blade, the lacrimal sac and then the nasal mucosa were opened in an “H” shaped fashion to form larger anterior and smaller posterior flaps. The anterior flaps of the nasal mucosa and the lacrimalsac were sutured by using interrupted sutures with 6.0 vicryl. The incision was closed in layers and a dressing was applied. The duration of surgery was measured from the making of the incision on the skin to the end of the closure of the skin incision by suturing.

All procedures were done under local anaesthesia. The nasal cavity was sprayed with a 10% xylocaine spray and it was packed with a roller gauze which was soaked in 4% xylocaine with adrenaline 1:10,000.

The mucosa of the lateral nasal wall was infiltrated with 2% xylocaine with 1:2,00,000 adrenaline, just anterior to the attachment of the middle turbinate. A 1x1cm piece of mucus membrane which was anterior to the uncinate process was incised and excised with a 15 No. Bard Parker blade. The lacrimal bone overlying the lacrimal sac area was removed by using punch forceps. The lacrimal sac was visualized after the removal of the lacrimal bone. More bone was removed to expose the medial wall of the sac. The lacrimal part of the fossa was removed upto the base of the uncinate process. Thus, about 1x1cm of bone was removed to expose the medial wall of the sac completely. The excessive bleeding was controlled by applying gauze strips which were dipped in a solution of 4% xylocaine with 1:10,000 adrenaline. The lacrimal sac was confirmed endoscopically by applying pressure on the outside over the medial canthus and the bulging of the sac was noticed intranasally. Externally, the eye was anaesthetized with 4% xylocaine drops, the lower punctum was dilated and a Bowman’s probe was inserted in order to tent the medial wall of the sac intranasally. The tented mucosa of the sac was incised by a sickle knife and the medial wall of the sac was excised. Lacrimal sac syringing was done with normal saline and a free flow of the fluid was observed endoscopically. The nose was packed with Neosporin ointment smeared ribbon gauze on the operated side. All the patients were discharged on the day following surgery and were called for regular follow-up. The patency of the lacrimal passage was investigated by sac syringing

Results

The present study involved 40 cases. They were divided into two groups of 20 each. Group I underwent external DCR and Group II underwent endoscopic endonasal DCR

It was found that a majority of the patients who underwent surgery were in the 3rd and 4th decades of life (62.5%)(Table/Fig 1)

A female preponderance was noticed in this study. Only 20% (8 patients) were males as compared to 80% (32 patients) females.

Chronic dacryocystitis was the most common aetiology (80%), followed by mucocoele of the lacrimal-sac (20%). Both were idiopathic in nature.(Table/Fig 2)

60% of the patients (12) presented with left sided symptomatology, as compared to 40% (8) with right sided symptomatology.(Table/Fig 3)

- In this study, it was found that bleeding was the most common intraoperative complication (45%). 35% of the patients had moderate bleeding,either during punching of the lacrimal bone or while making an incision on the nasal mucosa (Table/Fig 4). The bleeding was stopped by placing a ribbon gauze which was soaked in dilute adrenaline. One patient (5%) had severe bleeding while making the skin incision, due to injury to the angular vein, which may have been due to the varied anatomical position or the accessory vein. Haemostasis was attained by clamping and ligating the vein and the operation was continued (Table/Fig 5)

Identification of the sac was difficult in Group II, because of the variable position of the sac and the middle turbinate attachment. One patient required the resection of the anterior end of the middle turbinate, because it was hypertrophied and was obscuring the endoscopic view, as the sac was located posteriorly(Table/Fig 6). Woog et al (1998) reported that 33% of their patients required the resection of the anterior end of the middle turbinate.(9)

whereas 10% of the patients had severe bleeding. - Tearing of the anterior nasal flap was seen in 2 patients, as the nasal flaps were thin and friable. It was difficult to suture these flaps to the lacrimal sac flap.(Table/Fig 7)

6 patients (30%) had moderate bleeding and 3 patients (15%) had severe bleeding during the surgery. - The middle turbinate was traumatised in 1 patient (5%). - The ethmoidal air cells were accidentally entered in 3 patients (15%). - There was a difficulty in making a bone window in 3 cases (15%) because of thick bones.

It was observed that endoscopic DCR took less time (Mean duration = 46 mins) as compared to external DCR (Mean duration = 76 mins), which was statistically significant (P = 0.0001), as the duration of surgery was shorter in group II.

It was found that obstruction at the rhinostomy site and wound infection were seen in 10% of the patients and epistaxis was seen in 5% of the cases.

As in group I, obstruction at the rhinostomy site was the most common post operative complication (10%).

The lacrimal drainage system was patent in 18 patients (90%) at the end of 6 months in both the groups. Hence, the success rate was 90% in both the groups.(Table/Fig 8)(Table/Fig 9)

Discussion

We found chronic dacryocystitis to be more common in the lower socio-economic groups. A maximum incidence was seen in the 3rd and 4th decades of life. In a study which was conducted by Cokker et al (2000), the age of the patients ranged from 4 to 76 years.(4) HB Whittet et al (1993) observed that the age of their patients ranged from 14 to 80 years.(5) In the present study, the patients were aged between 16 to 68 years of age. 80% of the patients were females and 20% were males. In a study conducted by Sprekelsen et al (1996), 80% of the patients were females and only 20% were males.(6) Most studies have demonstrated that 70 to 80% cases of chronic dacryocystitis occurred in females. The striking prediliction for females can be explained by the narrower lumen of the bony naso-lacrimal canal. It is also possible that endocrine factors may be playing a role in the aetiology of chronic dacryocystitis.

The commonest cause of chronic dacryocystitis was found to be idiopathic blockage of the naso-lacrimal duct. In a study by Manfred Weidenbecher et al (1994), it was found that 78.5% of the cases had an idiopathic cause,(7) while Kristin J Tarbet et al (1995) found it in 72% of the cases.(8) The rest of the cases were either traumatic or infective (Lacrimal abscess, acute dacryocystitis). The major difficulty which was encountered in Group I, was bleeding that hampered visualization. 7 cases (35%) had moderate bleeding(9).

Rebeiz et al., in his study, noticed that during the endonasal procedure, the removal of the anterior end of the middle turbinate was helpful to expose the sac area, to locate the sac and to decrease the risk of scarring and fibrosis after the operation.(10) The surgical duration in group I was between 60 to 90 minutes with an average of 75 minutes and in group II, it was between 30 to 60 minutes with an average of 45 minutes. The endonasal approach took less dissection time as compared to that in the external approach. Tarbet et al (1988) recorded an average of 100 minutes for external DCR.(11) Our study correlates well with Hartikainen et al’s study, who noticed a surgical duration of 38 minutes for endoscopic dacryocystorhinostomy and 78 minutes for external dacryocystorhinostomy.(12) Both the procedures had minimal intraoperative and post-operative complications. Endoscopic DCR totally avoided an external scar, injury to the medial palpebral ligament and injury to the angular vein. The greatest advantage of endoscopic DCR was that, after having made a wide excision of the lacrimal sac, the result could be checked on the operating table itself. The procedure was accomplished without interference from any of the external structures surrounding the eye-ball. A success rate of 90% was observed in both the approaches. The success of the procedure was defined as a patent lacrimal drainage system at the end of 6 months.The success rate of external DCR has been reported at 90% to 97%, depending on the surgeon’s experience. (Olver JM, 2003)13. The success rate of endoscopic DCR has been reported between 82% to 86% (Rice DH et al, 1990; Shun Shin et al, 1998).(2)(13)(14) Our success rate with endoscopic DCR was comparable to the success rate which has been described for external DCR.

Conclusion

It can be concluded that endoscopic DCR is as good as external DCR for the treatment of primary nasolacrimal duct obstruction and chronic dacryocystitis.

The surgical duration for endoscopic DCR is short as compared to that of the external approach. Endoscopic DCR avoids a scar on the face and injury to the neighbouring structures like the medial palpebral ligament and the angular facial vessels. With the widespread use of nasal endoscopes, this surgery is gaining popularity over external dacryocystorhinostomy.

References

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. Susan MH. The history of lacrimal surgery. Adv Opthal Plastic Reconstruct Surg. 1986;139 – 168.
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. Rice DH.Endoscopic intranasal dacryocystorhinostomy: Results in 4 patients. Archieves of Otolaryngology.1990; 116:1061.
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. Mc Donough M, Meiring JH.Endoscopic transnasal dacryocystorhinostomy. Journal of Laryngology and Otology.1989; 103:585-587.
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. Cokker, Yasar et al .Comparative external versus endoscopic dacryocystorhinostomy: Results in 115 patients. Otolaryngology-Head and Neck Surgery.2000; 123: 488-491.
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. Whittet et al . Functional endoscopic transnasal dacryocystorhinostomy Eye 7 .1993; 545 – 549.
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. Kristine J, Tarbet et al. External dacryocystorhinostomy. Optholmology.1995; Vol. 102: No.102: No.1.
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. Woog JJ. Endonasal endoscopic dacryocystorhinostomy. Archives of otolaryngology – Head and neck surgery.1998; 124 : 328 – 333.
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. Rebeiz. Anatomic guidelines for dacryocystorhinostomy. Laryngoscope. 1992; 102:72-79.
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. Tarbet KJ. External dacryocystorhinostomy. Opthalmology. 102 : 1065-70.
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. Hartikainin, Jounko et al. Prospective randomised comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope. 1998;108:1861-1866.
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. Olver JM. The success rates of endonasal dacryocystorhinostomy. British Journal of Opthalmology.2003; 87 (11) : 1431.
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. Shun Shin GA, Thunrairajan G.External DCR- an end of an era?. British Journal of Opthalmology, South Asia.1998;1:11-12.

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