Aesthetic External DCR: The Subciliary Approach

Abstract

External dacryocystorhinostomy (Ex-DCR) is considered as the gold standard for surgical correction of primary acquired nasolacrimal duct obstruction. It can be performed safely in patients under local anesthesia, with minimal blood loss and economic cost, and has a high success rate of over 90% in most published series. Despite superior success rate, the inevitable downside of Ex-DCR has been an external skin scar, which has led to the evolution of endonasal and several other non-incisional techniques. An ideal DCR technique, therefore, would be one that allows a large bony ostium and good mucosal anastomosis without an external scar, and a subciliary approach is an important step in that direction.