Dacryocystorhinostomy in Congenital Nasolacrimal Duct Obstruction: A Multidisciplinary Approach

• DOI: https://doi.org/10.22533/at.ed.15948224020910

• Palavras-chave: Congenital Nasolacrimal Duct Obstruction; Pediatric Ophthalmology; Endoscopic Surgery; Dacryocystorhinostomy

• Keywords: Congenital Nasolacrimal Duct Obstruction; Pediatric Ophthalmology; Endoscopic Surgery; Dacryocystorhinostomy

• Abstract: INTRODUCTION The introduction discusses congenital nasolacrimal duct obstruction (CNLDO), a prevalent condition in pediatric ophthalmology, characterized by tear drainage issues due to developmental anomalies. It outlines the anatomy and physiology of the lacrimal system in neonates, the common congenital conditions leading to nasolacrimal duct obstruction, and the role of different specialties in diagnosis and management. The evolution of dacryocystorhinostomy (DCR) as a treatment option is reviewed, highlighting the differences between external and endoscopic approaches, the role of imaging and anesthesia, and the need for a multidisciplinary approach involving ophthalmologists, otorhinolaryngologists, and plastic surgeons. The introduction sets the stage for a discussion on the various aspects of DCR, including recent advancements and future perspectives. OBJETIVE To evaluate the indications, techniques, and outcomes of dacryocystorhinostomy (DCR) in managing congenital nasolacrimal duct obstruction (CNLDO). METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Congenital Nasolacrimal Duct Obstruction” AND “Pediatric Dacryocystorhinostomy” OR “Endoscopic DCR Techniques” OR “Multidisciplinary Surgical Approach” AND “Pediatric Oculoplastic Surgery” in the last years. RESULTS AND DISCUSSION The results and discussion provide a comprehensive analysis of the outcomes of DCR, comparing external and endoscopic techniques in terms of success rates, patient selection, and management strategies. It explores the role of anatomical variations and adjunctive procedures, such as silicone intubation and balloon dacryoplasty, in improving surgical outcomes. The discussion also covers the role of imaging in preoperative planning, the challenges of managing postoperative complications, and the impact of patient-specific factors, including age and co-existing conditions. It emphasizes the importance of a multidisciplinary approach to care and the benefits of recent advancements in minimally invasive surgical techniques. The section also examines the psychological and social impacts of the procedure, the importance of interdisciplinary collaboration, and the financial implications of different surgical approaches. CONCLUSION The conclusion underscores the importance of individualized patient care and a multidisciplinary approach in managing congenital nasolacrimal duct obstruction with DCR. It highlights the evolving nature of DCR techniques, with a growing emphasis on minimally invasive approaches and the integration of advanced technologies. The conclusion advocates for continued research, improved surgical strategies, and equitable healthcare policies to enhance access to specialized care, optimize clinical outcomes, and improve the quality of life for pediatric patients with CNLDO.