Endoscopic dacryocystorhinostomy

Multiple recent published studies have confirmed the value of the endoscopic dacryocystorhinostomy technique in the treatment of lacrimal obstruction. Significant refinements in technique and instrumentation coupled with an improved understanding of the endoscopic surgical anatomy are largely responsible for the excellent success rates now reported. The advantages of endoscopic dacryocystorhinostomy include the absence of skin incision and scar, preservation of the pump mechanism of the orbicularis oculi muscle, less disruption of medial canthal anatomy, decreased operating time, decreased intraoperative bleeding, and the ability to address concurrently nasal cavity or paranasal sinus abnormalities. Success appears to be dependent on several key aspects: (1) a thorough understanding of the endoscopic anatomy and location of the lacrimal sac, (2) efficient removal of frontal process of maxilla to expose completely the medial wall of the lacrimal sac, and (3) careful incision of the sac to achieve adequate exposure of the common internal punctum. This article describes the authors’ method for performing endoscopic dacryocystorhinostomy.