Contraindications for Endoscopic Laser Dacryocystorhinostomy

The endonasal approach is inappropriate in the presence of malignant lesions of the lacrimal system or the surrounding tissues. In active Wegener's granulo-matosis any instrumentation induces marked adhesions and stenosis, and a DCR by any method is con-traindicated. Dacryoliths usually require an external approach for removal. A relative contraindication is a history of trauma as the bone medial to the sac may be thick. The indications and contraindications for laser DCR are summarized in Table 7.4.

Table 7.4. Indications and contraindications for laser DCR

Indications for laser DCR Distal nasolacrimal duct obstruction Acute dacryocystitis

Revision surgery for failed external DCR Patients unfit for a general anesthetic Patients with a coagulopathy

Contraindications Tumors of lacrimal system Wegener's granulomatosis

Abnormally thick bone (e.g., nasoethmoid trauma) Lacrimal sac pathology

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