The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic dacryocystorhinostomy.
Endoscopic dacryocystorhinostomy (DCR) is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction (NLDO). This can be caused by chronic stenosis of the nasolacrimal duct and can be congenital or acquired. NLDO is common but is not a serious condition.
Presenting symptoms include excessive epiphora (tearing) and dacryocystitis (infection). Usually, cases have been refractory to conventional treatment such as warm compresses, massage and probing the nasal passage. If NLDO is left untreated, these symptoms persist and may cause embarrassment for the patient.
The external DCR is standard treatment. Endoscopic DCR is a minimally invasive procedure performed by ophthalmologists and otorhinolaryngologists to unblock tear ducts and correct other causes of decreased patency of the nasal passages.
A decongestant is administered to clear the nasal passage first and then gauze, soaked with anaesthesia that numbs the area and constricts blood vessels, is inserted.
A rigid endoscope is inserted into the nasal cavity to the lacrimal sac via the lacrimal duct to explore and confirm the nature of the obstruction. The nasal mucous membrane is incised and removed, to allow for the creation of a window 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 assist long-term patency.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.