Nasal to nasal and lacrimal to lacrimal approximation may cause obliteration of lacrimal fistula
. Patency depends on the correct approximation of mucosal flaps, to stabilize the flaps various methods were introduced like fashioning of different type of flaps, suturing of flaps, stabilization by clips etc.
Patients with any type of previous surgical treatment for epiphora, lacrimal fistula
as well as post traumatic cases were excluded.
A congenital lacrimal fistula is a rare developmental anomaly, usually unilateral.
A congenital lacrimal fistula is a rare developmental anomaly that is caused by an interruption in the embryogenesis of the nasolacrimal system.
(1) There may be an acute exacerbation of chronic dacryocystitis amounting to lacrimal abscess, which eventually may rupture and heal or form a chronic discharging lacrimal fistula
. An infected lacrimal sac (chronic) is a constant source of infection and minor corneal abrasions are of daily occurrence, which go unnoticed and with a coexisting chronic dacryocystitis may lead to corneal ulceration and all its complications.
AETIOLOGICAL DISTRIBUTION: In our study, chronic dacryocystitis was the most common etiology for nasolacrimal duct obstruction, which accounted for 40 cases (80%), followed by chronic dacryocystitis with mucocele in 6 cases (12%) andin 4 cases (8%) patients were having lacrimal fistula
of Cases Percentage Lacrimal sac--swelling 22 22% Lacrimal fistula
09 09% Positive regurgitation 45 45% test Conjunctival--Hyperemia 34 34% Corneal--Ulcer 04 04% -Opacity 11 11% Anterior chamber-Hypopyon 02 02% Table 8: Bacteriological Examination of Sac Contents in Chronic Dacryocystitis Organism No.
The table 3 shows that majority of the patients who underwent dacryocystorhinostomy had chronic dacryocystitis (77.78%) as the etiological cause in both the groups, followed by mucocele of the sac (18.52%) and lacrimal fistula
(3.70%) in some patients.
External dcr Endonasal dcr 1 Nasal packing required required 2 Acute dacryocystitis Not indicated indicated 3 Lacrimal fistula
indicated Not indicated 4 Skin incision + - 5 Tissue handling Less + ++ 6 bleeding + ++ 7 Endoscope & TV set Not required required 8 Post-operative scar Faintly + - 9 Closing of surgical wound + - 10 Surgical time 50-60 min 40-50 min 11 I/O bleeding 20% 25% 12 P/O bleeding 5 10 13 Wound dehiscence nil 14 Success rate 90% 85%
* 80% cases operated were suffering from chronic dacryocystitis, 10% of cases were having mucocele and 10% of cases presented with lacrimal fistula
The patients presented with persistent watering, Mucopurulent regurgitation, Swelling in sac area (mucocele), Lacrimal fistula
which are usually the classical presentation of patients with dacryocystitis as described in the literature.
Out of 861 patients, 12 (1.39%) presented with lacrimal abscess and 18 patients (2.09%) presented with lacrimal fistula
and 135 patients (15.67%) were operated under general anaesthesia.