الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Obstruction of the nasolacrimal duct results in disturbed tear outflow and can result in epiphora, punctal discharge, medial canthal swelling or dacryocystitis from secondary bacterial infection.
The majority of obstructions of the lacrimal outflow system are acquired ones and involve the distal parts of the system. Acquired obstruction may be primary or secondary to a variety of infectious, inflammatory, traumatic or neoplastic causes mimicking idiopathic inflammation.
These cases of lacrimal drainage system obstruction are treated by external dacryocystorhinostomy (DCR), which involves creating a fistula between the lacrimal sac and nasal cavity, bypassing the obstruction of the nasolacrimal duct.
A visible skin incision is usually mentioned as one of the disadvantages associated with this procedure and is used as a reason to recommend endonasal or other nonincisional techniques.
Previously published studies about DCR have shown that patient satisfaction may not necessarily correlate with objective success rates, and in case of a cutaneous scar, the only reliable way to ascertain the significance of the scar is from patient feedback.
There have been few studies that have addressed the visibility of external DCR scars, and recommendations to minimize it.
The present study was conducted to compare between continuous running monofilament sutures, subcuticular sutures, and the use of isoamyl 2-cyanoacrylate adhesive tissue glue in closure of the wound of external dacryocystorhinostomy, and assess the aesthetic results of the wound of the external DCR.
In this prospective interventional study, 45 eyes of 41 patients with chronic dacryocystitis underwent external DCR for acquired NLDO
The eyes included were 37 females (82.2%) and 8 male (17.8%).
The mean age of the study group was 29.82. Four of the 41 patients with lacrimal duct obstruction were bilateral cases (9.75%).
31 of the cases were classified as Fitzpatrick skin type IV (68.9%), and 14 cases were classified as Fitzpatrick skin type III (31.1%).
The 45 cases of the study were classified into 3 groups, 15 cases each. There was no statistical difference in the demographic data nor the Fitzpatrick skin typing between the three groups.
The overall success rate according to subjective assessment was 86.66%.The syringing test demonstrated patent lacrimal drainage system in 42 cases (93.33%).
According to the Hollander wound evaluation scale at one week post-operative, there was no statistical difference in the mean of the total score between the three groups.
Comparing the three study groups results using Stony brook scar evaluation scale at 3 months post-operative showed no statistical difference between the mean of the total score between the three groups.
As for the subjective assessment of the scar done 3 months post-operative using a questionnaire, there was no statistical difference in the mean of the total score between the test groups, even though that the tissue adhesive glue group and the subcuticular suturing group showed a higher mean but it wasn’t statistically significant.
Regarding the overall appearnce of the scar using the objective scales, at the 1 week postoperative follow up, 27 cases were seen as unsatisfactory overall appearance (poor overall appearance) (60%), and 18 cases was seen as satisfactory (good overall appearance) (40%), while at the 3 months follow up, only 13 cases were regarded as unsatisfactory (poor) appearance (28.89%), in comparison to 32 cases regarded as satisfactory (71.11%).
Using the subjective scale at the 3 months follow up, 27 cases graded their scar to be invisible or minimally visible (60%), in comparison to 18 cases graded their scar to be moderately or very visible (40%).
Findings from our study together with previous series from the literature have led to the recommendation that there is no advantage of one type of wound closure over the other, and that the scaring of the external DCR, as problematic as it may seem, tends to decrease with time.