title: Long-Term Success of Modified External Dacryocystorhinostomy for the Treatment of Distal Common Canalicular Block.
abstract: OBJECTIVE
  Epiphora caused by common canalicular obstruction is difficult to manage. Distal common canalicular block caused by membranous obstruction near its junction with the lacrimal sac can be managed by modified dacryocystorhinostomy (DCR) consisting of internal membranectomy. We report our experience with this technique during long-term follow-up.
  
  
  METHODS
  A prospective interventional case series was performed at a tertiary care center including 15 patients with a diagnosis of distal common canalicular obstruction.
  
  
  METHODS
  External DCR was performed, and after lacrimal sac opening, membranous obstruction at the distal end of the common canaliculus was identified and managed successfully in all cases. Mitomycin C was applied, and silicone intubation was done for 2 months. The main outcome measures were anatomical success (patent syringing) and functional success (complete relief of epiphora) at a minimum follow-up period of 1 year.
  
  
  RESULTS
  Fourteen (93%) cases were completely relieved of epiphora with patent lacrimal syringing at a mean follow-up of 15.4 months (P = 0.0001, McNemar test). The postoperative complications occurred in 4 cases and included nasal bleeding, lateral displacement of silicone tube at medial canthus, complete extrusion of silicone tube (at 4 weeks), and noticeable incisional scar.
  
  
  CONCLUSIONS
  Distal common canalicular obstruction can be successfully managed with DCR with internal membranectomy and silicone intubation with mitomycin C. It avoids excision of common canaliculus as compared with canaliculo-DCR. The procedure is safe and effective with minor complications.
authors.affiliation: From the Guru Nanak Eye Center, Maulana Azad Medical College, New Delhi, India.
authors.forename: Sushil
authors.initials: S
authors.lastname: Kumar
authors.forename: Pratima
authors.initials: P
authors.lastname: Dulgach
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kamal
authors.forename: Ruchi
authors.initials: R
authors.lastname: Goel