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To the Editor.
—Most dacryocystorhinostomy (DCR) wounds are relatively "dry," but profuse bleeding can occur. This letter briefly reviews the control of DCR hemorrhage based on experience with more than 250 DCRs with special emphasis on the use of the suction cautery.A fiberoptic focused coaxial headlight to brightly illuminate the depths of the DCR wound is essential. Packing the nose with neurosurgical cottonoids soaked in phenylephrine hydrochloride (Neo-Synephrine) solution (0.5% in adults and 0.25% in children) reduces bleeding from the nasal mucous membrane. Injection of the incision site with lidocaine hydrochloride (Xylocaine)-epinephrine solution minimizes soft-tissue bleeding.Three cauteries should be available for all DCR operations: the unipolar, bipolar, and suction cauteries. Bleeding in the subcutaneous and muscular tissue is effectively controlled with the bipolar cautery. Bleeding from the surface of the lacrimal and nasal bones before the DCR stoma is created is best controlled with the unipolar cautery. In
Small RG, Reed J. Bleeding During Dacryocystorhinostomy: The Importance of the Suction Cautery. Arch Ophthalmol. 1990;108(5):638–639. doi:10.1001/archopht.1990.01070070024010
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