Dacryocystitis is a common disease in ophthalmology, with a higher incidence in women than men. The pioneering of lacrimal sac nasal anastomosis has provided an effective method for the treatment of dacryocystitis and has been the gold standard for the treatment of dacryocystitis. Currently, there are two types of lacrimal sac nasal anastomoses Introduction to ocular trauma Ocular trauma is a category of ocular disorders that seriously affects visual function. Injuries often involve multiple parts of the eye and are severe, such as damage to the lens that can cause cataracts, damage to the ciliary body and anterior chamber angle that can cause abnormal intraocular pressure, and damage to the back of the eye that can cause vitreous hemorrhage, mechanization, and retinal detachment. Therefore, it requires a surgeon with extensive experience in ophthalmology to be able to treat it.
The surgical access methods are: the lacrimal sac nasal anastomosis through a skin incision (commonly known as “external” DCR surgery) and the lacrimal sac nasal anastomosis through a nasal approach (commonly known as “internal” DCR surgery).
In clinical practice, when patients are diagnosed with “dacryocystitis” and surgery is recommended, they are often torn between choosing the “internal” or “external” procedure. In order to give you a better understanding, here is a detailed description of these two surgical methods.
The direction of normal tear drainage is from the upper and lower tear dots, into the upper and lower lacrimal ducts, summarizing into the common lacrimal duct and then into the tear sac and nasolacrimal duct, and finally discharged through the opening of the nasolacrimal duct in the lower nasal passage. When the nasolacrimal duct is obstructed and infected, “dacryocystitis” is formed. Tears and pus can enter the lacrimal sac through the lacrimal duct and the common lacrimal duct, but they are obstructed at the exit site of the nasolacrimal duct to the nasal cavity, and tears and pus are retained in the lacrimal sac, and when the lacrimal sac is squeezed, the purulent secretion will flow back into the conjunctival sac from the lacrimal sac through the lacrimal duct.
The purpose of the lacrimal sac nasal anastomosis is to establish a new tear drainage channel. Anatomically, there is only one bone separating the lacrimal sac and the nasal cavity, so during the lacrimal sac nasal anastomosis, only this bone separating the two needs to be removed to anastomose the lacrimal sac and the nasal cavity, forming an anastomosis with the lacrimal sac open to the nasal cavity, allowing pus and tears to flow into the nasal cavity through the new anastomosis.
Comparison of “external” DCR surgery and “internal” DCR surgery
Nasal anastomosis of the lacrimal sac through a skin incision
(“external” DCR procedure)
Nasal anastomosis of the lacrimal sac through a nasal approach
(“internal” DCR procedure)
Indications
Nasolacrimal duct obstruction
Chronic dacryocystitis
Nasolacrimal duct obstruction
Chronic dacryocystitis
lacrimal cysts
Acute dacryocystitis
Recurrent dacryocystitis
Treatment process
Hospitalization for 5-7 days, postoperative bandages for 2-5 days;
The stitches are removed in 7 days and the drainage tube is removed in 14 days;
1.5 to 2 cm skin scar on the face after surgery
Hospital stay 2-3 days;
No bandage and stitch removal after surgery;
No scar on the face after surgery
Surgical Approach
Anastomosis creation: skin incision
Incision of subcutaneous tissue
Incision of the orbicularis muscle
Incision of the medial canthal ligament
Creation of bone foramen
Incision of nasal mucosa and lacrimal sac mucosa
Creation of anastomosis
Suture the medial canthal ligament
Suture the orbicularis muscle and subcutaneous tissue
Suture the skin (end of surgery) Make anastomosis: incision of nasal mucosa
Creation of bone foramen
Incision of the lacrimal sac mucosa
Creation of anastomosis (end of surgery)
Intraoperative conditions
Operating field: narrow, dark, unclear
Operating field: well-lit, magnified, clear
Postoperative tear drainage diagram
Inadequate tear drainage, possibility of “tear overflow” after surgery
Adequate tear drainage, little possibility of “tear overflow” after surgery
Postoperative appearance
1 week after “external” DCR
3 months after surgery
1. Chronic dacryocystitis
Before “internal” DCR, after “internal” DCR
2.Lacrimal cysts
Before “internal” DCR, after “internal” DCR
3.Acute dacryocystitis
Before “internal” DCR, after “internal” DCR
4.Recurrent dacryocystitis
Before “internal” DCR, after “internal” DCR
Postoperative examination
Rinse the tear duct and judge the postoperative effect
1.Rinsing the tear duct to judge the post-operative effect
2.The nasal endoscope directly checks the anastomosis, removes the granulation, removes the factors that cause recurrence, and increases the success rate of the operation.
Advantages and disadvantages
Advantages: higher success rate and lower treatment cost;
Disadvantages: more traumatic, facial skin scarring, slightly less effective tear drainage.
Advantages: high surgical success rate, wide range of indications, minimal surgical trauma (minimally invasive), short surgical time and hospital stay, little postoperative pain, no facial scars, good lacrimal drainage;
Disadvantages: slightly higher treatment cost.
In conclusion, “minimally invasive” surgery has become the development trend of contemporary surgery, and “internal” lacrimal sac nasal anastomosis is always respected by patients and doctors for its remarkable superiority.