Dacryocystorhinostomy: an Out-patient Procedure.

CONSIDERABLE stress has been laid on the necessity of careful in-patient treatment and post-operative care in cases of dacryocystorhinostomy. In most busy hospital departments it is sometimes extremely difficult if not impossible to cope with all the chronic dacryocystitis cases who require this operation and consequently the waiting list tends to get out of hand, and many of these waiting cases return in the interval with acute attacks of dacrycocystitis and all its attendant complications. To overcome this problem we have for some years treated these cases as outpatients in an attempt to show that hospitalization may not be necessary. This procedure enables the patient to be given an appointment for operation straight away, and as the operation is seldom more than 3 weeks ahead the waiting list is eliminated. Pre-operative Investigations All patients have an-E.N.T. examination to eliminate the possibility of intra-nasal disease. Secondly it is noted whether there is positive evidence of patency of the canaliculi. In cases in which it is not possible to pass the cannula into the sac, this fact is entered in the patients' notes, and the surgeon is then prepared to treat an ampullary block at operation as well as the possibility of a blocked naso-lacrimal duct. Many of these cases of apparent ampullary stenosis are found at operation to be perfectly patent, the stenosis being in fact due to kinking. This is particularly true of patients with rather tight mucoceles, which are distorting the anatomy and pressing on the medial end of the canaliculi before they pass in to the sac. This demonstration of patency on the operating table is simpler than many methods involving radio-opaque substances and radiological diagnosis. Operative Technique Where possible, patients are given a local anaesthetic before they go to the operating theatre; this anaesthetic is administered in three ways: (1) By local infiltration with procaine and adrenalin. This injection aims at: (a) Infiltrating the infra-orbital canal. (b) Picking off the infratrochlear nerve. (c) Infiltrating the subcutaneous area at the site of operation.