PURPOSE: To study intranasal causes of failure of external dacryocystorhinostomy (DCR). DESIGN: A retrospective study of clinical data from transnasal endoscopic findings after failure of external DCR. METHODS: Assessment of 65 patients with failure after external dacryocystorhinostomy; subjectively by patient's symptoms and saccharine test and objectively by patency on syringing, functional endoscopic dye test and endonasal endoscopic assessment. RESULTS: Endoscopic findings revealed: 20 cases intranasal adhesions, 8 cases septal deviation and concha bullosa, 8 cases abnormal size fistula, 6 cases rhinosinusitis, 6 cases contact granuloma, 3 cases of pouch, 4 cases closed ostium, 10 cases no definite cause could be found (functional failure). Negative dye clearance test and non-detection of fluorescein on irrigatiom in 55 patients. Delayed dye clearance but detection of fluorescein on irrigation in 10 patients (functional failure). CONCLUSIONS: Nasal endoscopy is very important in diagnosing causes of failure of external DCR. Nasal endoscopy is essential before and after external DCR. DCR should be done by a team work of rhinologist and ophthalmologist. Study of mucociliary clearance of lacrimal pathway will help to improve our surgeries and whether to do small or large fenestra technique.
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