Endoscopy in Ophthalmology

The nasal endoscope provides natural access through the nose to orbit, lacrimal sac, superior orbital fissure, optic canal and pituitary thus serving to treat problems in these areas.

Eg: For chronic watering problem due to infection of the lacrimal sac, Endoscopic DCR has the following advantages:

• There is no external scar
• Reduced bleeding during surgery
• The lacrimal pump mechanism is maintained.
• Patient looks unoperated.
• Takes less than 10 minutes usually
• Age no bar
• Successful in traumatic, congenital, failed DCR
• Cataract surgery can be taken up earlier than the external method
• Both sides can be taken up at the same time

Endoscopic Dacryocystorhinostomy:

Endoscopic dacryocystorhinostomy (DCR) is a simple process performed by ophthalmologists and otorhinolaryngologists to clean out the tear ducts and correct other causes of decreased patency of the nasal passages. A stern endoscope is inserted into the nasal cavity to the lacrimal sac through the lacrimal duct to find out and confirm the nature of the obstruction. The nasal mucous membrane is cut and detached, to allow for the formation of a gap on the lacrimal sac and upper nasolacrimal duct. A portion of the lacrimal and maxilla bone is removed and using a blade. A vertical incision is made in the lacrimal sac and nasolacrimal duct. Silicone tubes can be inserted to aid long-term patency.

Optic Nerve Schwannoma:

A 25 year old male with protrusion and pain right eye of 9 months duration underwent surgery – craniotomy and lateral orbitotomy twice elsewhere with no benefit. He finally approached our hospital. Endoscopic complete removal of the tumour was done. Even after 4 yrs of follow up, the patient is doing fine and has no problems.

Optic canal and the optic nerve can well be approached through the nose after a spheno ethmoidectomy for:

• Traumatic neuropathy
• Optic nerve sheath fenestration in papilloedema
• Optic canal decompression in craniosynostosis
• Optic canal decompression in fibrous dysplasia etc