Factors Affecting the Outcome of External Dacryocystorhinostomy in Al‐Thawra Hospital in Sana’a – Yemen.

Abstract

Factors affecting the outcome of external dacryocystorhinostomy in AL-Thawra Hospital in Sana’a – Yemen Objectives: To evaluate the outcome of external DCR in order to determine the factors affecting its results, so as to improve its outcome. Design: Prospective, non- comparative, hospital- based study design. Place and duration: AL-Thawra Hospital Sana’a – Yemen from February 2004 to October 2008. Methods: This study included one hundred twenty patients who had been diagnosed as having nasolacrimal drainage obstruction and booked for surgery in the Department of Ophthalmology at ALThawra Hospital. Ext-DCR was done by more than one surgeon. The surgical procedures were exactly the same in all patients, except that seventeen of them recived subcutaneous injection of adrenaline and xylocaine at the site of skin incision and nasal packing with adrenaline and xylocaine according to the V permission of the anaesthetist. Silicone intubation was done for all patients. The patients assessed on the second day, one week, two months and six months postoperatively. The results of Ext-DCR surgeries were evaluated by objective findings such as irrigation and fluorescin dye disappearance test and subjective symptoms by asking the patients about the condition of tearing improvement. Results: Our study showed that the age of the patients ranged from 8 to 70 years, most of them belonged to the middle age group with the mean age of 31.5 years and female predominance. The indications for Ext-DCR were chronic dacryocystitis, congenital nasolacrimal duct obstruction, primary acquired nasolacrimal duct obstruction, previous failure DCR and trauma respectively. The success rate was 96% and the complications recorded were not dangerous. Conclusion: External DCR combined with silicone intubation shows a high success rate in our study which is consistent with what was mentioned in the literature. The lowest success rate of Ext-DCR was in those patients with trauma while patients with revision of previous failed DCR had the highest success rate. VI External DCR has minimum complications in the form of mild to moderate intra-operative bleeding, wound infection and skin scarring. Recommendations : proper pre-operative assessment for the patients in order to see if there is no contra-indications for the subcutaneous injection of adrenaline xylocaine at the site of the operation and nasal packing with adrenaline and xylocaine in order to reduce the amount of intra-operative bleeding. The osteotomy size should not be less than 1.5cm x 1.5cm . ENT examination should be done when needed