What is Endonasal Dacryocystorhinostomy (DCR)?

From the Research

Definition and Purpose of Endonasal Dacryocystorhinostomy (DCR)

• Endonasal Dacryocystorhinostomy (DCR) is a surgical procedure that aims to restore drainage of tears by bypassing a blockage in the nasolacrimal duct, through the creation of a bony ostium that allows communication between the lacrimal sac and the nasal cavity 1.
• The primary purpose of DCR is to treat nasolacrimal duct obstruction, which can cause symptoms such as epiphora (excessive tearing), sac swelling, and purulent secretions 2.

Surgical Techniques and Approaches

• Endonasal DCR can be performed using various techniques, including laser-assisted, mechanical, and endoscopic approaches 1, 3.
• The endoscopic approach has become a popular alternative to the external approach, with advantages including no surface scar and minimal damage to the surrounding tissues 4, 5.
• A modified technique that preserves the nasal and lacrimal mucosa has been shown to have a high success rate, with 98% of patients experiencing relief from epiphora and a patent system at 3 months post-surgery 4.

Indications and Success Rates

• Endonasal DCR is commonly used to treat primary acquired nasolacrimal duct obstruction, but its indications are expanding to include other conditions such as DCR revisions, acute lacrimal sac abscesses, and common canalicular obstructions 5.
• Success rates for endonasal DCR have been shown to rival those of the external approach, with some studies reporting success rates of up to 98% 4.
• The use of mitomycin C and mucosal flap formation have been shown to improve success rates, especially in revision surgery 5.

Complications and Limitations

• Complications of endonasal DCR can include intraoperative bleeding, postoperative bleeding, and wound infection 1.
• The evidence on complications is generally of very low certainty, due to the limited number of studies and the variability in reporting outcomes 1.
• Further research is needed to fully establish the safety and efficacy of endonasal DCR, particularly in comparison to the external approach 1, 5.