Write the indications and contraindications of Endoscopic DCR.

Indications of endoscopic DCR :

1. Epiphora associated c 10 acquired Naso Lacrimal Duct (NLD) obstruction
2. Infection of Lacrimal sac associated c 10 acquired NLD obstruction.
3. NLD obstruction 20 to specific inflammatory infiltrative disorder.
4. The level of obstruction that is distal to the junction of the lacrimal sac and the duct.
5. In the management of lacrimal duct injuries associated sinus surgery.

Contraindication of endoscopic DCR :

1. Presence of a firm indurated mass above the level of medial canthus
2. Bloody epiphora
3. Presence of bony destruction as seen in radiological film.
4. Pseudoepiphora(It is essentially reflux tearing in which the main gland over compensate secretion because of lack secretion from minor glands of along the lid margin).

Remarkable History of DCR

External dacryocystorhinostomy: Toti

1st dacryocystorhinstomy: Celus

Endonasal approach: 1st described: caldwell, west and Mosher

1st performed: Mc Donogh

Anterior lacrimal crest: Frontal process of maxillary

Posterior  lacrimal crest: Lacrimal bone

Jones test:

1. It is a test of the patency of the nasolacrimal system.
2. Fluorescein is placed in the conjunctival sac and visualized in the nose after a period of 5 minute, there is impaired outflow →proximal obstruction , dye seen→distal obstruction.

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