Endoscopic DCR (Dacryocystorhinostomy)

Overview

Endoscopic Dacryocystorhinostomy (EDCR) is a sophisticated surgical procedure designed to address problems with the tear drainage system, specifically the nasolacrimal duct. This minimally invasive technique is used to treat conditions that obstruct the normal flow of tears from the eyes into the nasal cavity, such as chronic dacryocystitis or nasolacrimal duct obstruction. In this blog, we'll explore what EDCR entails, its indications, procedure, benefits, and aftercare.

What is Endoscopic Dacryocystorhinostomy (EDCR)?

EDCR is a minimally invasive surgical procedure that utilizes an endoscope—a thin, flexible tube with a light and camera—to access and repair the nasolacrimal duct. The procedure involves creating a new pathway for tear drainage from the lacrimal sac (the tear sac located near the inner corner of the eye) to the nasal cavity. Unlike traditional Dacryocystorhinostomy, which requires external incisions, EDCR is performed through the nasal passages.

The EDCR Procedure

1. Preparation

Consultation and Evaluation

• Medical History: The ophthalmologist or ENT specialist reviews the patient's symptoms, medical history, and prior treatments.
• Diagnostic Tests: Imaging studies, such as a dacryocystogram or CT scan, are performed to assess the extent and location of the obstruction.

Pre-Procedure Instructions

• Anesthesia: The procedure is usually performed under local anesthesia with sedation or general anesthesia, depending on the patient’s comfort and the complexity of the case.
• Fasting: If general anesthesia is used, patients may need to fast for a certain period before the procedure.

2. Procedure Steps

Anesthesia and Positioning

• Anesthesia: Anesthesia is administered to ensure the patient is comfortable and pain-free during the procedure.
• Positioning: The patient is positioned with the head tilted backward to provide optimal access to the nasal cavity and tear drainage system.

Endoscopic Access

• Insertion of Endoscope: The endoscope is gently inserted through the nasal passages to reach the lacrimal sac and nasolacrimal duct. The camera on the endoscope provides a real-time view of the area on a monitor.
• Creating the New Drainage Pathway: The surgeon makes an opening between the lacrimal sac and the nasal cavity to bypass the obstruction. Specialized instruments may be used to ensure a clear and functional pathway.

Inspection and Confirmation

• Evaluation: The surgeon inspects the new drainage pathway to confirm that it is clear and functional.
• Additional Procedures: If necessary, additional treatments, such as stenting, may be performed to support the new pathway and ensure proper healing.

Completion

• Endoscope Removal: The endoscope and any other instruments are carefully removed from the nasal passages.
• Post-Procedure Instructions: The patient is given instructions on care and what to expect during recovery.

Benefits of Endoscopic Dacryocystorhinostomy

• Minimally Invasive: Performed through the nasal passages with no external incisions, leading to less postoperative pain and a faster recovery.
• Improved Tear Drainage: Provides a new drainage pathway, effectively alleviating symptoms of tear duct obstruction and chronic dacryocystitis.
• Reduced Scarring: No external scarring as the procedure is done internally through the nose.
• Quick Recovery: Most patients experience a faster recovery compared to traditional dacryocystorhinostomy.

Risks and Complications

While EDCR is generally safe, potential risks and complications include:

• Bleeding: Some bleeding from the nasal passages or lacrimal sac may occur.
• Infection: There is a risk of infection at the site of the new drainage pathway.
• Persistent Symptoms: In some cases, symptoms may persist or recur if the obstruction is not fully addressed.
• Damage to Surrounding Structures: There is a small risk of damaging nearby structures, such as the nasal septum or sinuses.

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