Surgical Techniques & Management Flashcards
What are the Surgical Techniques & Management
(PIBDCC)
I. Probing & irrigation
II. Intubation
III. Balloon Dacryoplasty
IV. Dacryocystorhinostomy (DCR)
V. Canaliculodacryocystorhinostomy
VI. Conjunctivodacryocystorhinostomy (CDCR)
a delicate surgical maneuver that is facilitated by immobilization of the patient & by contraction of the nasal mucosa with a topical vasoconstrictor
Probing & irrigation
In ______, irrigation & probing are limited to the canalicular system and are performed for ___________ only
adults; diagnostic purposes
Performed with a silicone stent
Intubation
Success rate greater than 70% (after failed probing)
Intubation
Intubation is indicated for
a. Children who have recurrent epiphora following nasolacrimal system probing
b. Older children whom initial probing reveals significant stenosis or scarring
Intubation is useful for treatment of
(CTA)
Canalicular stenosis
Trauma
Agenesis of the puncta
Keys to successful intubation include
a. Shrinkage of nasal mucosa with a topical vasoconstrictor
b. Adequate lightning with a fiber-optic headlight
(Intubation) Simple square knot
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)
A collapsed balloon catheter is placed in a manner similar to probing and inflated inside the duct at multiple levels
Balloon Dacryoplasty
Used successfully in congenital nasolacrimal obstruction
Balloon Dacryoplasty
Balloon Dacryoplasty is indicated to
- Complicated cases
- Recurrence following standard probing techniques
Treatment of choice for most patients with acquired NLDO
Dacryocystorhinostomy (DCR)
Done by creating an anastomosis between the lacrimal sac & the nasal cavity through a bony ostium
Dacryocystorhinostomy (DCR)
Active infection should be treated, if possible, before _________ is performed
Dacryocystorhinostomy (DCR)
DCR indications
(RCPB)
- Recurrent dacryocystitis
- Chronic mucoid reflux
- Painful distension of the lacrimal sac
- Bothersome epiphora
Types of DCR surgical approaches
- Internal (intranasal/endonasal)
a. Lack of a visible scar
b. Shorter recovery period
c. Less discomfort - Extenal (transcutaneous) - traditional approach
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
Canaliculodacryocystorhinostomy
is used for the reconstructed canalicular system
Silicone stent
A procedure that is performed when one or both canaliculi are severely obstructed
Conjunctivodacryostorhinostomy (CDCR)
This procedure creates a complete bypass of the lacrimal drainage system
Conjunctivodacryocystorhinostomy (CDCR)
CDCR indications
- Canalicular abnormality is so severe
- Canalicular system cannot be used or reconstructed
How is CDCR done
(AGATS)
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
