Instructional Session: ISW11

Wednesday 4 July 2018, 16.45-17.45

Dacryocystorhinostomy (DCR): a bi-disciplinary approach

Pranter Brahmabhatt, Heikki Whittet, Garry Shuttleworth, Jake Ahmed, Morrison Hospital, Swansea

Dacryocystorhinostomy (DCR) for the surgical treatment of epiphora falls into the remit of both ENT and Ophthalmic surgeons. A bidisciplinary specialized clinic involving representation from both of these specialties has been operational in this department since 1994, providing a tertiary service to this area, and which has proved to be invaluable in the management of nasolacrimal conditions locally.

The objective for this instructional session is to highlight relevant aspects of assessment, investigation and management of patients presenting with nasolacrimal symptoms. The classification of sites of nasolacrimal obstruction, both proximal and distal, will be presented and the concept of functional epiphora / functional nasolacrimal block introduced. The process of selection of suitable cases for surgical management will be illustrated.

This session will be aimed at ENT trainees and consultant ENT surgeons with a special rhinological interest who may wish to establish a similar service.

The session will involve demonstration by an Ophthalmologist and ENT Surgeon with video and clinical images to highlight relevant nasolacrimal and nasal anatomy, nasolacrimal probing and endonasal assessment. Indications for investigations such as nasolacrimal scintigraphy, dacryocystography (DCG) and CT-DCG will be discussed and demonstrated and the various pathophysiological abnormalities illustrated.

Learning outcomes:
• To appreciate the anatomy of the nasolacrimal system and its relation to endonasal anatomy
• To learn about ophthalmic and ENT considerations in the diagnosis of epiphora
• Appropriate investigations and their interpretation
• Surgical considerations and approaches
• Common pitfalls