Indications for Endoscopic Laser Dacryocystorhinostomy

Dacryocystorhinostomy (DCR) is indicated for significant symptoms such as epiphora due to nasolacrimal duct obstruction which is not relieved by simple probing and syringing. It is not indicated for sole obstruction in the puncti, canaliculi, common duct, and lacrimal sac. In many patients there is some proximal obstruction associated with distal blockage. In such cases, gentle probing and dilatation in conjunction with a DCR and insertion of stents can be performed, although the results of such an approach are not as favorable as cases of pure distal blockage. The laser DCR can also be used in cases of acute dacryocystitis complicated by abscess formation (Morgan et al. 2004). The laser DCR is ideal when a patient is antico-agulated or has a coagulopathy. Not only does it avoid any disruption to their anticoagulant therapy, but it can also be done as a day-case procedure (Smithard et al. 2003). It is also more amenable to being performed under local anesthetic than other techniques, which is useful in those patients unfit for a general anesthetic. A relative indication for laser DCR is revision surgery for a failed external DCR (Szubin et al. 1999). An external DCR may be unsuccessful for several reasons, but predominantly it is due to excessive scarring that is often only a thin membrane blocking the rhi-nostomy. Revision surgery can be performed effec tively with the laser, removing the scarred tissue bloodlessly, although the outcome cannot be reliably predicted on account of excessive scarring which may involve the canaliculi and the common canaliculus. It is important that during the procedure the laser power setting be high enough to effect vaporization, rather than charring, since the latter will mean that further laser energy and heat may be dissipated to surrounding tissue and produce more scar tissue.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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