Evidence-based review of surgical practices in endoscopic endonasal dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction and other new indications.

PURPOSE OF REVIEW: To review the current surgical practices in endoscopic endonasal dacryocystorhinostomy (EN-DCR) from the studies of last 12 months.

RECENT FINDINGS: Success rates in EN-DCR now rival those of the conventional external approach. Indications are expanding beyond primary acquired nasolacrimal duct obstruction to include DCR revisions, acute lacrimal sac abscesses, nasolacrimal duct obstructions in patients who have received chemotherapy or radiation, and common canalicular obstructions. There is limited evidence that intubation with silicone stents improves the outcomes. Mitomycin C appears to improve the success rates of EN-DCR, especially revision surgery. Concomitant procedures, such as septoplasty and anterior middle turbinectomy, are sometimes required in primary as well as revision EN-DCR to achieve high success rates. There is increasing evidence that silicone stents are of limited benefit, whereas mucosal flap formation has been of benefit in case series.

SUMMARY: With innovations and improvements in the endonasal approach, EN-DCR has become a viable alternative to external DCR for primary acquired nasolacrimal duct obstruction. EN-DCR has the distinct advantages of no surface scar and a lack of damage to the pump mechanism that often occur with external DCR. Recent evidence indicates a comparable success rate to external DCR.