Surgical Techniques & Management

Question 1

What are the Surgical Techniques & Management

(PIBDCC)

Answer 1

I. Probing & irrigation
II. Intubation
III. Balloon Dacryoplasty
IV. Dacryocystorhinostomy (DCR)
V. Canaliculodacryocystorhinostomy
VI. Conjunctivodacryocystorhinostomy (CDCR)

Question 2

a delicate surgical maneuver that is facilitated by immobilization of the patient & by contraction of the nasal mucosa with a topical vasoconstrictor

Answer 2

Probing & irrigation

Question 3

In ______, irrigation & probing are limited to the canalicular system and are performed for ___________ only

Answer 3

adults; diagnostic purposes

Question 4

Performed with a silicone stent

Answer 4

Intubation

Question 5

Success rate greater than 70% (after failed probing)

Answer 5

Intubation

Question 6

Intubation is indicated for

Answer 6

a. Children who have recurrent epiphora following nasolacrimal system probing

b. Older children whom initial probing reveals significant stenosis or scarring

Question 7

Intubation is useful for treatment of

(CTA)

Answer 7

Canalicular stenosis
Trauma
Agenesis of the puncta

Question 8

Keys to successful intubation include

Answer 8

a. Shrinkage of nasal mucosa with a topical vasoconstrictor

b. Adequate lightning with a fiber-optic headlight

Question 9

(Intubation) Simple square knot

Answer 9

a. Silicone tubing secured with

b. Which allows removal of the tube through canalicular system in a retrograde fashion (to be relieves through the nose)

Question 10

A collapsed balloon catheter is placed in a manner similar to probing and inflated inside the duct at multiple levels

Answer 10

Balloon Dacryoplasty

Question 11

Used successfully in congenital nasolacrimal obstruction

Answer 11

Balloon Dacryoplasty

Question 12

Balloon Dacryoplasty is indicated to

Answer 12

• Complicated cases
• Recurrence following standard probing techniques

Question 13

Treatment of choice for most patients with acquired NLDO

Answer 13

Dacryocystorhinostomy (DCR)

Question 14

Done by creating an anastomosis between the lacrimal sac & the nasal cavity through a bony ostium

Answer 14

Dacryocystorhinostomy (DCR)

Question 15

Active infection should be treated, if possible, before _________ is performed

Answer 15

Dacryocystorhinostomy (DCR)

Question 16

DCR indications

(RCPB)

Answer 16

• Recurrent dacryocystitis
• Chronic mucoid reflux
• Painful distension of the lacrimal sac
• Bothersome epiphora

Question 17

Types of DCR surgical approaches

Answer 17

1. Internal (intranasal/endonasal)
   a. Lack of a visible scar
   b. Shorter recovery period
   c. Less discomfort
2. Extenal (transcutaneous) - traditional approach

Question 18

A procedure where the area of total common canalicular obstruction is removed, and the remaining patent canalicular system is directly anastomosed to the lacrimal sac mucosa or the lateral nasal wall mucosa

Answer 18

Canaliculodacryocystorhinostomy

Question 19

is used for the reconstructed canalicular system

Answer 19

Silicone stent

Question 20

A procedure that is performed when one or both canaliculi are severely obstructed

Answer 20

Conjunctivodacryostorhinostomy (CDCR)

Question 21

This procedure creates a complete bypass of the lacrimal drainage system

Answer 21

Conjunctivodacryocystorhinostomy (CDCR)

Question 22

CDCR indications

Answer 22

1. Canalicular abnormality is so severe
2. Canalicular system cannot be used or reconstructed

Question 23

How is CDCR done

(AGATS)

Answer 23

a. After creating a rhinostomy opening into the nose, a JONES TUBE is placed through an opening creating at the inferior half of caruncle & then through the osteotomy site into the middle nasal meatus

b. GOLD DILATORS is used to enlarge the mucosal opening prior to insertion of the JONES TUBE

c. a PARTIAL CARUNCULECTOMY may be needed to prevent obstruction of the tube

d. The OCULAR END OF THE TUBE must be situated in the TEAR LAKE, whereas the NASAL END must clear the ANTERIOR END OF THE MIDDLE TURBINATE

e. SUBTOTAL RESECTIONS of the ANTERIOR MIDDLE TURBINATE may be necessary