Page 128 - NAME OF CONDITION: REFRACTIVE ERRORS

taken.

 Imaging: CT Scans are useful in elucidating facial skeletal anomalies, fractures
or foreign bodies as the cause of lacrimal disorder. It is also useful rule out
occult malignancy or mass as a cause of dacryocystitis.
Dacryocystography(DCG) with subtraction or CT-DCG is very sensitive to study

the anatomy of the lacrimal sac and surrounding structures. Dacryoscintigraphy
(DSG) is done with the help of Technetium 99 and gamma camera and is useful
in providing certain insights into the functional causes of epiphora.

c) Treatment: The treatment strategies should be revisited to check for adequacy,
appropriateness and affordability. If the culture and other tests show a different
organism, then the treatment regimen should be modified.

Surgical procedure includes:

1. External Dacryocystorhinostomy or repeat external DCR as described in the
earlier section.

2. Endoscopic endonasal revision of past DCR.

3. Endoscopic guided secondary intubations

4. Canalicular trephining and use of monoka stents

5. Laser assisted DCR or Laser assisted revision of a failed DCR.
6. Conjunctival DCR with Jones tubes.

7. Balloon assisted DCR revision.

8. Balloon dacryoplasty and canaliculoplasty.

STANDARD OPERATING PROCEDURE

a. In Patient :
 All procedures planned under general anesthesia.
 Revision DCR’s as there is more tendency to bleed in postoperative period.
 Patients with complications like orbital cellulitis on referral or postoperative

severe bleeding.
b. Out Patient: Not applicable.
c. Day Care: Patients after the surgical procedure are kept under observation for 4-
5 hours for any bleeding and then can be discharged if they are stable.

d) Referral criteria: not applicable.

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