Endoscopic transnasal dacryocystorhinostomy

Objectives: To improve the success rate and reduce the morbidity associated with the external approach to dacryocystorhinostomy (DCR), we adopted endoscopic transnasal DCR (ETDCR) for the treatment of epiphora and studied its efficacy. Materials and Methods: From January 2000 to December 2001, 16 patients with epiphora due to nasolacrimal duct obstruction were referred to our department for ETDCR. Eleven of the patients had bilateral obstruction and five had unilateral obstruction (27 eyes total). Under 4-mm, 30° nasoendoscopic guidance, a circumlinear mucosal incision was made 1 cm superior and anterior to the attachment of middle turbinate, extending downward along the maxillary line. Then, a Stammberger-Saches intranasal drill and a 15° curved intranasal drill were used to remove a piece of the lacrimal bone and maxillary frontal process to expose the lacrimal sac. A Silastic stent was then implanted and left for at least 6 months. Transnasal endoscopic follow-up was performed once every 2 week for the first month after stent placement and then once per month for 6 months. Results: Symptomatic improvement was categorized into four categories 6 months after surgery. Twenty-two (82%) eyes had excellent and four (14%) showed good improvement in symptoms. One (4%) eye was unchanged. The only complication was mild ecchymosis of the medial canthus area (12/27 eyes). Conclusion: We recommend ETDCR as an alternative to external DCR. It has many advantages, such as shortened surgical time, minimal bleeding and preservation of orbicularis oculi muscle function. It is suitable for surgeons well trained in endoscopic sinus surgery.