High Definition Dacryoendoscopic Visualization of the Lacrimal Drainage System in Children with Congenital Nasolacrimal Duct Obstruction (CNLDO)

  • Nishi Gupta

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This video explains the procedure of Dacryoendoscopy (DEN), which is the intraluminal visualization of the lacrimal drainage system using a miniature endoscope coupled to a high-definition camera unit. It helps in the complete visualization of the lacrimal pathway from the punctum to the inferior meatus. Its utility in recalcitrant congenital nasolacrimal duct obstruction (CNLDO) has been proven.

Inability to perform successful recanalization in CNLDO may prompt the surgeon to proceed with DCR. DEN helps detect these obstructions and can also help prevent the need for surgery in few particular cases.

DEN has a steep learning curve with difficult localization of the landmarks. This video is beneficial in explaining the technical glitches, the way to overcome them and will provide clarity of identification of landmarks.

Introduction

This video explains the Dacryoendoscopy (DEN), which is the intraluminal visualization of the lacrimal drainage system using a miniature endoscope.

About The Author

Nishi Gupta

Dr. Nishi Gupta is currently the head of the Otorhinolaryngology and associate medical director at Dr. Shroff’s Charity Eye and ENT hospital New Delhi India. Her initial work on Endoscopic Dacryocystorhinostomy was compiled and was released by Dr. Shroff’s Charity Eye & ENT hospital in the form of a video cassette in 1999. She subsequently published three editions on Endoscopic dacryocystorhinostomy, first in 2006, second in 2011, and third in 2020 with Springer. She has published articles in various national and international journals and has reviewed national and three international journals.

Dr. Gupta obtained her MS degree in Otorhinolaryngology from Nagpur university in 1992, followed by a Postgraduate diploma in hospital management from NIHFW Delhi and training at Great Ormond Street Hospital for Children London. She popularized the technique of endoscopic dacryocystorhinostomy in the country. For more than two decades, her association with the only Eye & ENT institute helped her pursue her passion in endoscopic lacrimal sinus and orbital surgeries. She has been conducting annual live surgical demonstration workshops and hands-on cadaver dissection training sessions on endoscopic dacryocystorhinostomy and endoscopic sinus surgeries for more than two decades.

 

About this video

Author(s)
Nishi Gupta
DOI
https://doi.org/10.1007/978-981-19-4614-1
Online ISBN
978-981-19-4614-1
Total duration
13 min
Publisher
Springer, Singapore
Copyright information
© Producer, under exclusive license to Springer Nature Singapore Pte Ltd. 2022

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Video Transcript

[MUSIC PLAYING]

Hello, my name is Nishi Gupta, and I am working as Deputy Medical Director and Head Department of Otorhinolaryngology college at Dr. Shroff’s Charity Eye and ENT Hospital, New Delhi, India. This is a video on High Definition Dacryoendoscopic Visualization of the Lacrimal Drainage System in Children with Congenital Nasolacrimal Duct Obstruction.

Dacryoendoscopy is the intraluminal visualization of the lacrimal drainage system, using a miniature endoscope coupled to a high definition camera. 0.8 millimeter miniature straight endoscope which is semiflexible. It has a scale and an attachment for fibreoptic light transmission system, with a side port for irrigation. Dacryoendoscopy allows direct access to the punctum, to common canaliculi.

This is the schematic diagram. And this is the dacryoendoscopic picture of the intraluminal appearance of the punctum of the canaliculi, of the common canaliculi, and the lacrimal sac. We can see prominent mucosal folds, with pinkish color mucosa. And that’s the proximal end of the nasolacrimal duct. And it marks the transition of sac to the NLD.

So this is the area from where the NLD starts. And this is how it looks. This is the mid part of the nasolacrimal duct and that’s the distal part of the nasolacrimal duct, or the value of Hesnar area. And we can see a nice clear lumen with prominent mucosal folds. So this is a clear visualization of the nasolacrimal system, using a 0.8 millimeter dacryoendoscope.

This video includes use of dual camera, dacryoendoscopy in patient lacrimal drainage system, patent NLD with prominent mucosal folds, and clips on dacryoendoscopy in membranous congenital nasolacrimal duct obstruction. Dual camera situation has added benefit, as it allows visualization of intraluminal structure, using a 0.8 millimeter dacryoendoscope and parallel viewing of the nose, using 4 millimeter nasal endoscope.

So this use of dual camera has been shown in the subsequent video. This is not something that is needed routinely. But by learning the dacryoendoscopy, sometimes while inside the nasolacrimal system, the landmarks are lost and the visualization becomes difficult. So in that case, a parallel viewing through the nasal endoscope tells us about the location of this dacryoendoscope into the nasolacrimal system. So for learning purposes it is good, but it is not routinely required.

Dacryoendoscopic findings in membranous CNLDO are interesting, especially at the distal end of the nasolacrimal duct. The scope seems to be entering into a large blind pouch, which is formed due to bulging of this membrane, as shown here in the schematic diagram. And this membrane can be easily perforated. So that’s the nasolacrimal duct. This is that bulge– this membrane. And this hole is demarcated by this endoscopic picture.