Original Research Article DOI: 10.18231/2581-5016.2019.0006 IP International Journal of Ocular Oncology and Oculoplasty, January-March, 2019;5(1):24-27 24 Powered endoscopic dacryocystorhinostomy (DCR), raising the bars Sanjeev Kulkarni 1 , K.V. Satyamurthy 2 , Roopa Hiremath 3,* , Arati Jain 4 1 Medical Director, 2 Medical Superintendent, 3 Consultant, 4 Fellow, 3 Dept. of Oculoplasty, 3 Mahipathi Madhwacharya Joshi Eye Institute, Dharwad, Karnataka, India *Corresponding Author: Roopa Hirenath Email: roopsworld2000@yahoo.co.in Abstract Introduction: This study is done to assess the efficacy of powered endoscopic dacryocystorhinostomy (DCR) with large bony ostium exposing of fundus of sac and primary mucosal anastomosis. The study involved prospective interventional case series with short perioperative follow up. Materials and Methods: Operative and postoperative data were prospectively collected on 42 patients (15 men and 27women; mean age, 62.4 y; range 14–91 y) who presented to a lacrimal clinic with epiphora and obstruction of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. All surgeries done by the same surgeon by standardized surgical technique. Follow‐up evaluations included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit. Results: The only surgical complication was one case of sub cutaneous emphysema. 39 of the 42 DCRs had anatomically patent naso lacrimal duct after a mean follow‐up of 12 months (standard deviation = 5 months), yielding a success rate of 95.7%. Out of three failures two had closed ostium because of improper use of medications, one patient had granulation tissue at the ostium. Two patients with a patent ostium had functional block and continued to have some symptoms. Conclusion: Powered endoscopic DCR which meets the with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR. Keywords: Endonasal DCR, Powered DCR, Dacryocystorhinostomy. Introduction Dacryocystorhinostomy (DCR) is surgical procedure done for epiphora due to nasolacrimal duct obstruction (NLDO), which involves creating a fistulous opening between lacrimal sac and nasal cavity at the level of middle meatus. There are various procedures to create this ostium that is external DCR, endoscopic nasal DCR, laser DCR. The most accepted are external and endonasal DCR. Endonasal DCR initially had guarded acceptance because of inconsistent success rates. External DCR which is considered to be the gold standard procedure, now because of the introduction of newer techniques even endonasal DCR has success rate as comparable to the external DCR. In The conventional endonasal DCR the main hurdles are removing the thick maxillary process and creating a large ostium to expose the fundus of the lacrimal sac. The use of powered instruments to debride the thick bone has increased the success rate of endonasal DCR. In this study our objective is to evaluate the effectiveness of powered endonasal DCR that is removal of medial wall of the lacrimal sac with powered instruments Marathon M4 lab micro motor burr, which is economically most affordable compared to other micro motor burrs and preservation of the mucosa. In this study we have included 42 patients with NLDO who have undergone powered endonasal DCR by the same surgeon. The outcome and long term patency of the ostium were evaluated. Inclusion criteria Patients with nasolacrimal duct obstruction Patients above the age of 12 years Failed DCR Exclusion criteria Canalicular obstruction Primary nasal pathology (severe atrophic rhinitis, nasal polyp, gross DNS) Materials and methods 42 patients with complain of watering coming to lacrimal clinic between 2016 February to 2017 April were included in our study. Among them 15 were males and 27 were females. The most common aetiology of presentation was Primary Acquired naso lacrimal Duct Obstruction (PANDO), (Table 1). All the patients underwent thorough ocular examination, sac syringing, endoscopic examination of nasal cavity pre operatively (table 2) and patients with above inclusion criteria were included in the study. Surgical technique All the cases done under local anesthesia using 45 degree 4mm nasal endoscope. Nerve blocks are given to supratroclear nerve at supraorbital notch, ethmoidal nerve block is given at medial canthus, infraorbital nerve block given at infraorbital notch using 2%lignocain and 1:100000 adrenaline mixture. Nasal pack with 4% lignocaine and 2 ampules of adrenaline mixture placed for 20 minutes before surgery. Nasal mucosal infiltrate at the lateral nasal wall near middle meatus, middle turbinate and medial nasal wall is given using the same 2% lignocaine and 1:100000 adrenaline mixture. An inferior based mucosal flap is created with crescent (Fig. 1) blade first incision starting 10mm above the middle turbinate extending down till inferior turbinate, second vertical incision of similar length taken 10mm in front of the