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Obstruction Nasolacrimal Duct Follow-up

  • Author: Sandra R Worak, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 25, 2016
 

Further Outpatient Care

After the dacryocystorhinostomy, patients are given antibiotic eye drops and a nasal decongestant spray.

The silicone stent tube is removed after 3 months. In some situations (ie, Wegener granulomatosis), the stents may need to be retained indefinitely.

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Further Inpatient Care

Dacryocystorhinostomy may be performed as an outpatient procedure, especially if performed with a laser; there is less bleeding and faster recovery.

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Inpatient & Outpatient Medications

Antibiotic/steroid eye drops, such as tobramycin/dexamethasone combination eye drops, are prescribed postoperatively for use 2-3 times per day for 2-3 weeks as prophylaxis to infection and to decrease postoperative inflammation.

Nasal decongestant sprays are prescribed postoperatively for use 2-3 times per day for 2-3 weeks.

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Deterrence/Prevention

Early consultation when symptoms of tearing appear would be beneficial.

Appropriate antibiotics with lacrimal massage are the initial remedies for mild cases of obstruction.

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Complications

See the list below:

  • Excessive bleeding (epistaxis)
  • Poor/delayed wound healing
  • Wound infection
  • Accidental removal of tube/stent by the patient
  • Restrictive strabismus[29]
  • Lacrimal sump syndrome[30]
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Prognosis

Both external dacryocystorhinostomy and endoscopic laser dacryocystorhinostomy have success rates higher than 90%; external dacryocystorhinostomy is slightly more successful.

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Patient Education

Explain the following to the patient:

  • Normal lacrimal drainage process
  • Obstruction of lacrimal drainage passageway
  • Possible diagnostic tests that may be necessary to evaluate the condition and their possible results
  • Treatment protocols and options
  • If surgery is necessary, discuss the prognosis and possible intraoperative and postoperative complications.
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Contributor Information and Disclosures
Author

Sandra R Worak, MD Consulting Staff, Department of Orbit and Oculoplasty, Reconstructive and Lacrimal Surgery, East Avenue Medical Center

Sandra R Worak, MD is a member of the following medical societies: Philippine Medical Association, Philippine Academy of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Alfonso U Bengzon, MD, MBA Consulting Staff, Department of Ophthalmology; Section Head, Section of Oculoplastic and Orbit Surgery, Department of Ophthalmology, The Medical City General Hospital, Philippines; Consultant Head, The Medical City Diagnostic and Laser Eye Center

Alfonso U Bengzon, MD, MBA is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Ron W Pelton, MD, PhD Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Jorge G Camara, MD Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Disclosure: Nothing to disclose.

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Dacryocystitis of the left nasolacrimal system.
Dacryocystogram. A patent nasolacrimal system on the right side of a patient and a blocked system on the contralateral side at the level of the nasolacrimal duct.
Endoscopic laser-assisted dacryocystorhinostomy.
 
 
 
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