Endonasal Dacryocystorhinostomy

Endoscopic Endonasal Dacryocystorhinostomy (EE-DCR) is regarded as the treatment of choice for blocked nasolacrimal duct obstruction, having largely overtaken the external approach (transcutaneous) dacryocystorhinostomy (Ex-DCR) in popularity and being taught word-wide. However, a valued place remains for the external approach where the surgeon does not have either the endoscopic expertise nor equipment, and where infiltrative local anaesthetic surgery is the only option. The aim of both EE-DCR and Ex-DCR is entirely identical, which is to make an unimpeded opening into the nose from the lacrimal sac. Both achieve this end. Lacrimal surgeons should be trained in the anatomy and surgery of both EE-DCR and Ext-DCR as well as the less often used dacryocystectomy (DCT). Both Ext-DCR and EE-DCR have success rates in the region of 90%. Arguments remain on the use of silicone intubation.