title: Use of Direct Otoscope for Intranasal Examination After Dacryocystorhinostomy.
abstract: OBJECTIVE
  To evaluate whether the use of a direct otoscope in the nose is an effective method to observe the nasolacrimal anastomosis site after dacryocystorhinostomy.
  
  
  METHODS
  In 75 eyes undergoing external dacryocystorhinostomy, the lacrimal irrigation test was performed and fluorescein solution was instilled in the conjunctival sac. After applying topical anesthetics and decongestant, a direct otoscope was inserted in the middle meatus and directed toward the medial canthus.
  
  
  RESULTS
  In 69 eyes (92%), intranasal lacrimal examination with the otoscope could be performed. In 6 eyes (8%), the otoscope could not be adequately advanced in the nose because of middle meatal stenosis (n = 5 eyes) or intolerance to the intranasal examination (n = 1). In 66 (96%) of 69 eyes, concordant with the results of the lacrimal irrigation test, the presence or absence of fluorescein dye flow in the nose was observed. In this examination, the main features that were useful in locating the anastomotic area were (1) the use of fluorescein dye, (2) motility of the nasal mucosa that was synchronized with eyelid movements, (3) appearance of mucosal hole or internal orifice in the nasal wall, and (4) dye or air-fluid bubble emergence upon blinking or finger pressure over the sac region.
  
  
  CONCLUSIONS
  Direct otoscope can be effectively used in the nose for examining the nasolacrimal anastomosis in patients undergoing dacryocystorhinostomy.
authors: Department of Ophthalmology, Uludag University, Bursa, Turkey.
authors: Bulent
authors: B
authors: Yazici
authors: Huri
authors: H
authors: Sabur
authors: Nesimi
authors: N
authors: Orucov
mesh_terms: D003608:Dacryocystorhinostomy; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D019793:Fluorescein / Q000008:administration & dosage; D005456:Fluorescent Dyes / Q000008:administration & dosage; D006801:Humans; D007765:Lacrimal Apparatus / Q000187:drug effects; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000473:pathology*; D019720:Otoscopes; D011184:Postoperative Period
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein