A modified technique of external dacryocystorhinostomy with maintaining of pump function (Mini –DCR)

Purpose: To evaluate a new modified technique of external dacryocystorhinostomy(DCR) in maintaining of pump function and improvement of post-operative epiphora. Patients and methods: This is a prospective interventional case series including 30 consecutive patients with unilateral nasolacrimal duct obstruction presenting with epiphora without chronic dacryocystitis or mucocele. A modified external DCR (mini-DCR) was performed in all cases. In this technique we had performed the same steps of conventional external DCR but we did not disrupt the medial palpebral ligament , the lower half of the medial wall of the sac below the medial palpebral ligament is only opened and anastomosed with the adjacent nasal mucosa after performing an osteotomy and a silicon stent was applied and removed after 3 months. Results: This study included 30 cases with acquired NLD obstruction presenting with epiphora. They were 14 females(46.67%) and 16 males(53.33%). Mean age 37.33± 3.34 (range from 22 to 52 years). The mean surgical time was 55±4.3. After one month of mini-DCR 28 cases(93.33%) showed anatomical and functional patency. After 3 and 6 months of surgery 25 cases (83.33%) maintained patency. Conclusions: This study describe a new modified more conservative technique of external DCR with maintaining of pump function of the sac in cases of nasolacrimal duct obstruction presenting with epiphora without chronic dacryocystitis or mucocele resulting in parallel functional and anatomical success.