الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
DCR is the operation of choice to relief epiphora due to NLDO. DCR can be approached by one of two methods; the endonasal approach and the external approach.
In this study 60 cases were enrolled, 20 case had been operated upon with ExDCR , 40 cases with the EnDCR, half of them with silicone intubation and the others with otologic T-tube.
The results of this study came to be in harmony with most of the previous studies. The results of the transnasal EnDCR was 87.5% success rate about 7.5% higher than the ExDCR (80% success rate) but this difference was statistically non-significant.
However, EnDCR has several advantages over ExDCR, including the avoidance of external scar formation and preservation of the pump action of the orbicularis muscle. Additionally, acute infection of the lacrimal sac is not a contraindication for EnDCR, as it is for the conventional external technique. The mean duration of the ExDCR was 52.5 minutes which is longer than the mean duration of the endoscopic technique (39.75 minutes). Also convalescence following endonasal EnDCR is shorter than after the ExDCR due to absence of skin incision and sutures.
Nasal endoscopy has great promise as a diagnostic and therapeutic instrument in certain DCR failures.
EnDCR has became the standard treatment for patients with postsaccal obstructions of the lacrimal pathway. The most common reasons for failure in EnDCR are adhesions, restenosis or obstruction of the rhinostomy site.
Postoperative care is very important for the success of these surgical procedures. Local irrigation of the rhinostomy site with saline nasal spray and antibiotic–steroid eyedrops are very important for the prevention of the adhesions and obstruction of rhinostoma.
In the literature, the long term results of EnDCR either using silicone stents or otologic T-tube are comparable. In most studies concerning EnDCR, the number of paients is relatively small. The problem is statistically exaggerated when patients are divided into smaller groups. To provide reliable results, the group sizes should be larger.
The two critical factors to attain success in EnDCR are proper indication (postsaccal stenosis with normal or dilated sac) and proper marsupialization.
Based on the long-term success full surgical results in the current study of EnDCR with silicone intubation and otologic T-tube which are 90% and 80% respectively at 6 months, we recommend EnDCR with silicone intubation or with otologic T-tube as the treatment of choice in cases of chronic epiphora due to primary postsaccal nasolacrimal obstruction.