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Surgical intervention by dacryocystorhinostomy (DCR) is the mainstay treatment for epiphora resulting from nasolacrimal duct obstruction. The goal of this surgery is to reestablish lacrimal outflow by creating a bypass into the nasal cavity. Initially, DCR was performed as an external procedure, leaving patients with a scar in the medial canthal area and lower eyelid.
Over the past few decades, several advances in technology have enabled us to perform this procedure endoscopically to provide better cosmesis. Compared with external DCR, an endoscopic approach allows the surgeon to better navigate anatomic variations that might lead to failure of the surgery, such as a deviated nasal septum or an enlarged middle turbinate.
More recently, minimally invasive techniques like transcanalicular laser-assisted endoscopic DCR have gained popularity. Currently, this procedure is performed with an incision-free technique that avoids visible scarring, requires shorter operating time, produces less bleeding—and is easier to learn—than other DCR methods. Overall, the success rate of laser-assisted endoscopic DCR in relieving epiphora is reported to be between 60 and 90 percent.
Advantages of transcanalicular laser-assisted endoscopic DCR compared with conventional external DCR include the following:
1) minimal or no postoperative ecchymosis and edema,
2) less surgical manipulation of medial canthal tissues and lacrimal pump,
3) no scarring on the skin,
4) minimal bleeding,
5) faster recovery time.