Non-endoscopic Endonasal Dacryocystorhinostomy

Abstract

Caldwell [1] and Toti [2], respectively, described the endonasal and external approaches to dacryocystorhinostomy (DCR) [1, 2]. Because of difficulty in visualizing the nasal cavity, the endonasal approach fell out of favor, and for the next 100 years, a slightly modified external approach remained the treatment of choice for Primary Acquired Nasolacrimal Duct Obstructions (PANDO). Interest in endonasal DCR saw resurgence around 1990 with the availability of rigid and fiber-optic imaging systems. Despite these advancements, identification of the precise site for DCR remained a concern, because of the possibility of injury to adjacent orbital and intracranial tissues. In 1990, Bruce Massaro introduced the concept of transilluminating the lacrimal sac with a vitrectomy light pipe [3]. Over the last two decades, the technique and technology in endonasal DCR has evolved to make this an effective, scarless option in the treatment of NLDO with several authors reporting success rates (≥90 %) equivalent to that of external DCR [4–6].