Endoscopic dacryocystorhinostomy (DCR) is used to treat patients diagnosed with lacrimal sac or nasolacrimal duct obstruction (NLDO). This can be caused by chronic stenosis of the nasolacrimal duct and can be congenital or acquired. NLDO is common but is not a serious condition. The symptoms include excessive epiphora (tearing) and dacryocystitis (infection). Usually, cases have been refractory to conventional treatment such as warm compresses, massage and probing the nasal passage. The external DCR surgery is the standard treatment. Endoscopic DCR is a minimally invasive procedure performed by ophthalmologists and otorhinolaryngologists to unblock the tear ducts and correct other causes of decreased patency of the nasal passages. A rigid endoscope is inserted into the nasal cavity to the lacrimal sac via the lacrimal duct to explore and confirm the nature of the obstruction. The nasal mucous membrane is incised and removed, to allow for the creation of a window on the lacrimal sac and upper nasolacrimal duct. A portion of the lacrimal and maxilla bone is removed and using a blade, a vertical incision is made in the lacrimal sac and nasolacrimal duct. Silicone tubes can be inserted to assist long-term patency. DCR is a fairly simple outpatient procedure. Overall success rates exceed 90%, although in particular cases the likelihood of success may be lower. The risks and side effects of the procedure are relatively low, and can potentially lead to a long-lasting relief of bothersome tearing.
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