Atrophic rhinitis is a chronic, debilitating and recalcitrant disease of the nasal cavities that is prevalent in several parts of the world. It has unique epidemiological features and clinical characteristics. Clinicians and researchers for decades have tried to postulate theories for the aetiology of the primary form of the disease. Management of the disease has seen several medical therapeutic regimens including alternative forms of medicine. Surgical options for the condition are also not completely satisfactory with a number of failures and recurrences. The authors provide here a comprehensive review of the existing literature as regards the aetiology and management of this refractory condition.

Atrophic rhinitis is a chronic inflammatory disease of the nose, which is more common in India. Chronic dacryocystitis is its rare complication. The authors found four cases of chronic dacryocystitis from March 2002 to October 2003 due to atrophic rhinitis. It was diagnosed clinically by the regurgitation test and lacrimal syringing. These cases were treated conservatively for a period of six weeks to make the nasal mucosa healthier and were then subjected to endoscopic dacryocystorhinostomy (end-DCR) under local anaesthesia. The procedure was found to be more difficult due to bleeding and the healing time was prolonged as compared to other cases of end-DCR. After one to one and half years of follow-up the primary success rate was 75 per cent but after revision surgery in one case, all cases were successful. Hence it was concluded that atrophic rhinitis is no more a contraindication for end-DCR. However, meticulous initial preparation and post-operative follow-up is necessary to improve the result.