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Use of an image-guided navigation system for routine endonasal endoscopic dacryocystorhinostomy

  • O Reichel (a1) and M Taxeidis (a1)



This study aimed to evaluate the results of routine endonasal endoscopic dacryocystorhinostomy combined with computed tomography guided navigation in patients with nasolacrimal duct obstruction.


This was a retrospective study of all patients with lacrimal drainage obstruction undergoing stereotactic endoscopic dacryocystorhinostomy between 1st January 2016 and 1st April 2018. Computed tomography dacryocystography was used for intra-operative navigation. Patients with a presaccal obstruction site location were excluded from the study.


Endoscopic dacryocystorhinostomy with computed tomography guided navigation was successfully performed in all 17 cases without complications. Early post-operative dislocation of the inserted bicanalicular silicone stent occurred in two patients. Two other patients developed post-operative bacterial infection within the lacrimal sac. Otherwise, the silicone tube was removed three months after surgery, and after further follow up of 8 weeks, 94 per cent of the study population reported complete remission of epiphora.


The use of computed tomography guidance in routine endoscopic dacryocystorhinostomy enhanced safety for the patient and avoided unnecessary damage of bone and mucosa surrounding the lacrimal drainage system. Therefore, routine endoscopic dacryocystorhinostomy with additional stereotactic guidance by computed tomography navigation can contribute to high success rates with endoscopic dacryocystorhinostomy.


Corresponding author

Author for correspondence: Dr Oliver Reichel, Department of Otolaryngology, Head and Neck Surgery, Siloah St. Trudpert Hospital, Wilferdinger Str. 67, Pforzheim 75179, Germany E-mail:


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Dr O Reichel takes responsibility for the integrity of the content of the paper



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1McDonogh, M, Meiring, JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol 1989;103:585–7
2Ben Simon, GJ, Joseph, J, Lee, S, Schwarcz, RM, McCann, JD, Goldberg, RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology 2005;112:1463–8
3Cho, WK, Paik, JS, Yang, SW. Surgical success rate comparison in functional nasolacrimal duct obstruction: simple lacrimal stent versus endoscopic versus external dacryocystorhinostomy. Eur Arch Otorhinolaryngol 2013;270:535–40
4Horn, IS, Tittmann, M, Fischer, M, Otto, M, Dietz, A, Mozet, C. Endonasal lacrimal duct surgery: a comparative study of two techniques. Eur Arch Otorhinolaryngol 2014;271:1923–31
5Patel, BC. Management of acquired nasolacrimal duct obstruction: external and endonasal dacryocystorhinostomy. Is there a third way? Br J Ophthalmol 2009;93:1416–19
6Day, S, Hwang, TN, Pletcher, SD, Bhatki, A, McCulley, TJ. Interactive image-guided endoscopic dacryocystorhinostomy. Ophthlamic Plast Reconstr Surg 2008;24:338–4010.1097/IOP.0b013e31817e6133
7Morley, AM, Collyer, J, Malhotra, R. Use of image-guided navigation system for insertion of a Lester-Jones tube in a patient with disturbed orbito-nasal anatomy. Orbit 2009;28:439–41
8Ali, MJ, Naik, MN. Image-guided dacryolocalization (IGDL) in traumatic secondary acquired lacrimal drainage obstructions (SALDO). Ophthalmic Plast Reconstr Surg 2015;31:406–9
9Ali, MJ, Singh, S, Naik, MN, Kaliki, S, Dave, TV. Interactive navigation-guided ophthalmic plastic surgery: navigation enabling of telescopes and their use in endoscopic lacrimal surgeries. Clin Ophthalmol 2016;10:2319–24
10Ali, MJ, Singh, S, Naik, MN, Kaliki, S, Dave, TV. Interactive navigation-guided ophthalmic plastic surgery: the utility of 3D CT-DCG-guided dacryolocalization in secondary acquired lacrimal duct obstructions. Clin Ophthalmol 2016;11:127–33
11Ali, MJ, Singh, S, Naik, MN. Image-guided lacrimal drainage surgery in congenital arhinia-microphthalmia syndrome. Orbit 2017;36:137–43
12Penttilä, E, Smirnov, G, Tuomilehto, H, Kaarniranta, K, Seppä, J. Endoscopic dacryocystorhinostomy as treatment for lower lacrimal pathway obstructions in adults: Review article. Allergy Rhinol (Providence) 2015;6:1219
13Freitag, SK, Woog, JJ, Kousoubris, PD, Curtin, HD. Helical computed tomographic dacryocystography with three-dimensional reconstruction. Ophtalmic Plast Reconstr Surg 2002;18:121–3210.1097/00002341-200203000-00006
14West, JM. The transnasal technique for opening the nasolacrimal sac. Arch Laryngol Rhinol 1913;24:62–4
15Metson, R, Cosenza, M, Gliklich, RE, Montgomery, WW. The role of image-guidance systems for head and neck surgery. Arch Otolaryngol Head Neck Surg 1999;125:1100–4
16Leong, SC, MacEwen, CJ, White, PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy 2010;24:819010.2500/ajra.2010.24.3393
17Onerci, M, Orhan, M, Ogretmenoglu, O, Irkec, M. Long-term results and reason for failure of intranasal endoscopic dacryocystorhinostomy. Acta Otolaryngol 2000;120:319–22
18Bernal-Sprekelsen, M, Alobid, I, Tomas-Barberan, M, Della Rocca, RC, Schaefer, SD. Dacryocystorhinostomy surgical technique. In: Weber, RK, Keerl, R, Schaefer, SD, Della Rocca, RC, eds. Atlas of Lacrimal Surgery. New York: Springer, 2007;61–8
19Sarode, D, Bari, DA, Cain, AC, Syed, MI, Williams, AT. The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis. Clin Otolaryngol 2017;42:307–1410.1111/coa.12751
20Nomura, K, Arakawa, K, Sugawara, M, Hidaka, H, Suzuki, J, Katori, Y. Factors influencing endoscopic dacryocystorhinostomy outcome. Eur Arch Otorhinolaryngol 2017;274:2773–7
21Choi, JC, Jin, HR, Moon, YE, Kim, MS, Oh, JK, Kim, HA et al. The surgical outcome of endoscopic dacryocystorhinostomy according to the obstruction levels of lacrimal drainage system. Clin Exp Otorhinolaryngol 2009;2:141–410.3342/ceo.2009.2.3.141
22Yung, MW, Hardmann-Lea, S. Analysis of the results of surgical endoscopic dacryocystorhinostomy: effect of the level of obstruction. Br J Ophthalmol 2002;86:792–4
23Mueller, SK, Freitag, SK, Lefebvre, DR, Bleier, BS. Endoscopic DCR using bipedicled interlacing mucosal flaps. Laryngoscope 2018;128:794–7
24Tsirbas, A, Wormald, PJ. Endonasal dcryocystorhinostomy with mucosal flaps. Am J Ophthalmol 2003;135:768310.1016/S0002-9394(02)01830-5



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