Abstract :
Background: Chronic dacryocystitis occurs because of persistent infection and inflammation of the lacrimal sac, mainly due to obstruction at the level of the nasolacrimal duct. This condition often leads to continuous tearing and ocular discharge. Common factors contributing to the failure of dacryocystorhinostomy (DCR) surgery include common canalicular stenosis, sump syndrome, high anastomosis of the flap, and suboptimal surgical technique.Aim and Objective: To compare the post-operative surgical outcome in failed cases of chronic dacryocystitis.Materials and Methods: The present study was designed as a prospective, interventional, comparative, single-centre investigation conducted at a tertiary care facility over one year. It included a total of 60 patients with previously failed cases who had undergone surgery elsewhere, divided into two groups of 30 patients each through random sampling. Following a thorough history taking and examination, all participants underwent re-dacryocystorhinostomy with silicone tube intubation, along with the application of Mitomycin-C to the flap and circum-osteal area. In Group A, the silicone tube was removed after 4 weeks, while in Group B, it was removed after 6 weeks. The surgical outcomes were compared at the 12-month postoperative mark.Results: The success rate of a redo external dacryocystorhinostomy combined with silicone tube intubation was notably impressive. In Group A, the procedure achieved a success rate of 90% when the silicone tube was removed after 4 weeks. Conversely, Group B demonstrated an even greater success rate of 100% when the silicone tube was retained for an extended period of 6 weeks before removal. This highlights the potential benefits of optimising the duration of silicone tube placement in enhancing surgical outcomes.Conclusion: External DCR surgery using canalicular silicone tube intubation, combined with intraoperative mucosal flap and circum-osteal application of Mitomycin-C, can lead to excellent outcomes. The post-operative result was higher with a significant difference in patients where the silicone tube was removed at the 6th post-operative week.
Keyword :
Chronic dacryocystitis, Nasolacrimal duct obstruction, Failed dacryocystorhinostomy, Silicone tube intubation, Mitomycin-C, External DCR.