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비루관 폐쇄의 치료: 이비인후과 의사 관점에서

Management of Nasolacrimal Duct Obstruction: ENT Surgeon’s Perspective

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대한이비인후과학회 (Korean Society of Otorhinolaryngology-Head and Neck Surgery)|2017.10|대한이비인후과학회지 두경부외과학 (Korean Journal of Otorhinolaryngology-Head and Neck Surgery)|제60권 제10호|pp. 481-490|DOI https://doi.org/10.3342/kjorl-hns.2017.00745

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키워드

EpiphoraEndoscopyDacryocystorhinostomyOtolaryngology.
주제분류이비인후과학

초록

Epiphora is an overflow of tears onto the face and mainly occurs secondary to abnormal excretory system such as nasolacrimal duct obstruction (NLDO), which could be congenital or acquired. In past years, patients with NLDO have been usually managed by ophthalmologists using external dacryocystorhinostomy (EX-DCR) which has been considered the gold standard of treatment. Recently, the advancement of nasal endoscope and endoscopic sinus surgery has contributed to perform endoscopic DCR (EN-DCR), which now offers comparable success rate to EX-DCR with many advantages. ENT surgeons are familiar with intranasal anatomy and nasal endoscope handling rather than ophthalmologists. Therefore, these advantages lead to more ENT surgeons performing endoscopic DCR. However, the learning curves exist to reach a favorable success rate because surgical technique should be delicate in the narrow nasal cavity. This paper attempts to describe management of epiphora from ENT perspective, focus on surgical anatomy, evaluation modalities and update on endoscopic technique and surgical outcome compared with EX-DCR. This present review would serve as a guide for beginners and increase their confidence with endoscopic anatomy and correct management of epiphora including EN-DCR procedures. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(10):481-90

Abstract

Epiphora is an overflow of tears onto the face and mainly occurs secondary to abnormal excretory system such as nasolacrimal duct obstruction (NLDO), which could be congenital or acquired. In past years, patients with NLDO have been usually managed by ophthalmologists using external dacryocystorhinostomy (EX-DCR) which has been considered the gold standard of treatment. Recently, the advancement of nasal endoscope and endoscopic sinus surgery has contributed to perform endoscopic DCR (EN-DCR), which now offers comparable success rate to EX-DCR with many advantages. ENT surgeons are familiar with intranasal anatomy and nasal endoscope handling rather than ophthalmologists. Therefore, these advantages lead to more ENT surgeons performing endoscopic DCR. However, the learning curves exist to reach a favorable success rate because surgical technique should be delicate in the narrow nasal cavity. This paper attempts to describe management of epiphora from ENT perspective, focus on surgical anatomy, evaluation modalities and update on endoscopic technique and surgical outcome compared with EX-DCR. This present review would serve as a guide for beginners and increase their confidence with endoscopic anatomy and correct management of epiphora including EN-DCR procedures. Korean J Otorhinolaryngol-Head Neck Surg 2017;60(10):481-90

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