A prospective study on the effect of Dacryocystectomy on Epiphora and Quality of Life involving 45-60 years age group.

INTRODUCTION

BACKGROUND:

Dacryocystectomy is a recognized oculoplastic procedure that involves the complete surgical removal of the lacrimal sac. DCT, initially proposed as a treatment for nasolacrimal duct blockage by Woolhouse in 1724, remained the primary treatment for this issue until Toti advanced Dacryocystorhinostomy (DCR) in 1904 [1]. Despite being infrequently performed globally, it remains significant in situations where DCR is not a viable option. Dacryocystectomy nowadays is done for certain specific indications like malignant lacrimal sac tumors, It is almost always performed through an external skin incision.

Epiphora is the most common sign and the most troublesome symptom of obstruction of lacrimal drainage pathway. Linberg and McCormick (1986) coined the term primary acquired nasolacrimal duct obstruction (PANDO) to describe a nasolacrimal duct (NLD) obstruction caused by inflammation of unknown cause that eventually leads to occlusive fibrosis of the NLD [2]. Epiphora is an annoying symptom of PANDO and can have a great impact on the quality of life [3].

Currently, dacryocystectomy is primarily used for treating tumors of the lacrimal sac. Additional reasons for its use include chronic dacryocystitis, patients with significant systemic comorbidities , deformities of the nose or face, a potential for nasocutaneous fistulas following dacryocystorhinostomy, Wegener granulomatosis, and patients who are anxious or unsuitable for prolonged surgeries while supine. However, multiple studies indicate that dacryocystectomy may be a valid option for patients with nasolacrimal duct obstruction associated with dry eye, ocular scarring pemphigoid, Crohn’s disease, and systemic lupus. These indications imply a need to reassess and reposition this procedure within the existing surgical treatments for the lacrimal drainage system [4].

    RATIONALE:

Dacryocystectomy procedure consists of complete surgical extirpation of the lacrimal sac. Though the procedure does not create a bypass for tear drainage, removal of the lacrimal sac does not allow tear and lacrimal sac mucosal secretions to get accumulated, which can act as a conduit for infection. This not only relieves the patient from recurrent episodes of acute dacryocystitis, but also provides great relief in ocular discharge [5][6]. Alam and Kundu (2022) in their study published in the Indian Journal of Ophthalmology to look for relevance of Dacryocystectomy in reducing epiphora which shows subjective improvement in epiphora following Dacryocystectomy in 86.8% patients. After 6 weeks of surgery, none of them complained of postoperative discharge[7]. The primary aim of all these studies was to mention the effect of DCT on epiphora and Quality of life in patients belonging to age group of 45-60 years, in an era where DCR is commonly done for management of NLD obstruction.

                AIMS AND OBJECTIVES

General Objectives of this study:

·       To study the effect on epiphora in age group of 45-60 years after dacryocystectomy.

 ·       To study the changes in quality of life.

 Specific Objectives of this study:

·       To study the effect of Dacryocystectomy (DCT) on epiphora in age group of 45-60 years in cases where Dacryocystorhinostomy is contraindicated.

 ·       To study the changes in Watery Eye Quality of life after Dacryocystectomy.