Dacryocystorhinostomy
Dacryocystorhinostomy (DCR) is the main surgical option for nasolacrimal duct obstruction (NLDO), which essentially aims to create a bone window and then a communicating route between the tear (lacrimal) sac and nasal cavity, allowing tears to flow straight from the tiny tear ducts into nasal cavity, thereby bypassing the obstructed nasolacrimal duct.
There are 2 approaches to DCR:
The traditional method is external DCR, which comprises of creating an external cutaneous incision along the side of the nose and the inner corner of the eye.
The endoscopic approach, on the other hand, is a minimally-invasive technique which allows the surgeon to approach the lacrimal sac and nasal space through the nostril, without the need for a skin incision. This avoids the risk of a scar on the face. A pre-surgery assessment through the nasal endoscopic examination will need to be done to determine suitability.
In either technique, a bicanalicular silicone stent would be placed for a period of 4 to 6 weeks to keep the ostium patent. The anatomical success rate of DCR for cases of complete NLDO is in the range of 90 to 95%.