CHAPTER 76 Dacrocystorhinotomy (DCR) is done to make a new lacrimal duct. A brief description of the procedure follows: 1. A Bard-Parker scalpel handle #3 with a #15 blade is used to make an incision into the medial canthus. 2. A curved Halsted mosquito forceps may be used for blunt dissection to the orbicularis muscle. 3. A Freer elevator is used to separate the orbicularis muscle from the nasal bone. 4. A Freer chisel with a mallet may be used to punch a hole into the lacrimal bone. 5. A Kerrison rongeur can be used to enlarge the hole. 6. A Goldstein lacrimal sac retractor is placed for visualization. 7. A lacrimal dilator is used to dilate the inferior punctum. 8. Bowman lacrimal probes are passed into the lacrimal sac. 9. Stevens tenotomy scissors are used to incise the lacrimal sac and nasal mucosa. 10. A Castroviejo needle holder and suture are used to suture the posterior lacrimal sac to the posterior nasal mucosa. 11. Silastic lacrimal duct tubing is passed into the nose (to be removed after healing). 12. A Vienna nasal speculum may be placed in the naris to check the entrance of the tubing. 13. A Castroviejo needle holder with Castroviejo suture forceps are used to suture the anterior lacrimal sac flap and the nasal mucosa to form a tunnel for the silastic tubing.
Dacrocystorhinotomy (DCR)
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