Clinical Outcome of Dacryocystorhinostomy with Septal Deviation

Yoon Jung Lee; Sang-Won Moon; Hee Yoon Cho; Jin-Hyeok Jeong

doi:10.3341/jkos.2008.49.5.713

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Lee, Moon, Cho, and Jeong: Clinical Outcome of Dacryocystorhinostomy with Septal Deviation

Original Article

J Korean Ophthalmol Soc 2008;49(5):713-720.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.5.713

Clinical Outcome of Dacryocystorhinostomy with Septal Deviation

Yoon Jung Lee, M.D.¹, Sang-Won Moon, M.D.¹, Hee Yoon Cho, M.D.¹, Jin-Hyeok Jeong, M.D.²

¹Department of Ophthalmology, College of Medicine, Hanyang University, Gyunggi, Korea

²Department of Otolaryngology Head and Neck Surgery, College of Medicine, Hanyang University, Gyunggi, Korea

Address reprint requests to Yoon-Jung Lee, M.D. Department of Ophthalmology, Hanyang University Guri Hospital #249-1 Gyomoondong, Guri City, Gyunggi-do 471-701, Korea Tel: 82-31-560-2350, Fax: 82-31-564-9479, E-mail: lyjot@hanyang.ac.kr

Received 11 July 2007 Accepted 27 November 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Septal deviation has few subjective symptoms. However, a difficulty remains in doing DCR (dacryocystorhinostomy) in these patients. We investigate the clinical course of DCR in patients with a septal deviation.

Methods

Acquired nasolacrimal duct-obstructed patients who had undergone DCR with septal deviation from 2003 to 2006 in our hospital were retrospectively analyzed. We measured the septal distance using paranasal computed tomography taken preoperatively and compared the sex and age of patients, the kinds of operations, outcome of surgery, and ocular and nasal complications in our analysis.

Results

Twenty-two eyes of 22 patients with a mean age of 55.3 years (range 29∼74) were analyzed (4 males, 18 females). Mean septal distance was 4.84 mm (range 2.18∼6.99 mm). Nineteen eyes had endonasal DCR, and three had external DCR. Two had DCR combined with septoplasty. Three had septoplasty as a secondary operation, Nasal complication was synechiae in 9 eyes. DCR success was seen in 15 eyes, and DCR failure in 7 eyes. Septal distance was not correlated with DCR success but was correlated with nasal complication (Mann-Whitney test, p=0.003)

Conclusions

In the case of DCR with septal deviation, the surgical technique used will need to minimize the mucosal injury and ensure appropriate nasal correction to prevent future complications.

Keywords: Dacryocystorhinostomy, Nasolacrimal duct obstruction, Septal deviation

References

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Figure 1.

(A) the coronary image in paranasal computed tomography shows the shortest distance (2.14 mm) between inner surface of lacrimal fossa and outer surface of nasal septum. (B) the magnified image of the nasal space in A). (C) the axial image of a septal deviation patient shows the shortest nasal distance (2.4 mm). (D) the magnified image of the nasal space of C.

Figure 2.

Endoscopic view of the nasal cavity after dacryocystorhinostomy in septal deviation patients without mucous decongestion. (A) there is narrow nasal space. (B) in another patient there is too closed space to see the inner structure. (C) there is severe synechiae between the lateral nasal wall and septal deviation.

Figure 3.

Adhesion between the lateral nasal wall and nasal septum was observed (A). After synechiolysis was performed, there was shown nasal ostium and tube behind the synechiae (B) which had good function. A diagram of synechiae (C) and after synechiolysis (D).

Table 1.

The clinical characteristics of patients

No	sex/age	Septal distance (mm)	Op name	DCR success
No	sex/age	Coronary/axial	Op name	DCR success
1	F/40	2.85/2.44	EndoDCR c SI∗ +SP^†	S^∏
2	F/75	4.9/5.57	EndoDCR c SI∗ +SP^†+ESS^‡	S^∏
3	F/48	3.51/4.86	EndoDCR c SI∗ -> SP^†	F^#
4	M/53	2.18/2.4	EndoDCR c SI∗ -> SP^†	S^∏
5	F/41	3.5/5.18	ExtDCR^§ c SI ->SP^†	F^#
6	F/55	4.75/4.55	EndoDCR c SI∗	S^∏
7	F/56	4.39/5.5	EndoDCR c SI∗	S^∏
8	F/57	4.3/4.3	EndoDCR c SI∗	F^#
9	M/15	3.59/5.26	ExtDCR^§ c SI	F^#
10	M/49	5.13/4.26	EndoDCR c SI∗	S^∏
11	F/47	5.23/3.26	EndoDCR c SI∗	S^∏
12	F/64	5.65/3.15	EndoDCR c SI∗	S^∏
13	M/69	6.18/3.93	EndoDCR c SI∗	S^∏
14	F/69	5.01/5.29	EndoDCR c SI∗	S^∏
15	F/29	6.12/4.8	EndoDCR c SI∗	S^∏
16	F/74	5.95/8.81	EndoDCR c SI∗	F^#
17	F/59	4.85/7.69	EndoDCR c SI∗	S^∏
18	F/64	6.99/3.65	EndoDCR c SI∗	F^#
19	F/69	4.25/6.25	EndoDCR c SI∗	F^#
20	F/72	4.55/3.93	EndoDCR c SI∗	S^∏
21	F/67	5.96/4.30	ExtDCR^§ c SI	S^∏
22	F/48	4.2/3.3	EndoDCR c SI∗	S^∏

^† SP = septoplasty;

^∗ EndoDCR c SI = endonasal dacryocystorhinostomy with silicone tube insertion; surgery;

^‡ ESS = endoscpic sinus

^§ ExtDCR = external dacryocystorhinostomy;

^∏ S = success;

^# F = fail.

Table 2.

The ocular complications of patients

Complications	Frequency
Tube prolapse	3
Intermittent tearing	2
Conjunctivitis	1

Table 3.

The nasal complications of patients

Complications	Frequency
Synechiae	9
Membranous obstruction	5
Granulation	2

Table 4.

The comparison of two groups by septal distanc measured in coronary image

Septal distance	No	Nasal complication	DCR∗ success
< 5 mm	11	8	6
> 5 mm	11	1	9
Total	22	9	15
p-value		0.372	0.03
(Mann-Whitney test)

^∗ DCR = dacryocystorhinostomy.

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