Revision Dacryocystorhinostomy

  • Emmy Y. Li


Dacryocystorhinostomy (DCR) is performed to relieve nasolacrimal duct obstructions that cause epiphora or dacryocystitis. With the advances in instruments and techniques, both external (EXT-DCR) and endonasal endoscopic DCR (EN-DCR) achieve relatively high success rates with minimal complications. In cases of failure, the common causes include inadequately sized or inappropriately placed osteotomy or sac opening, scarring or granulation tissue at the ostium, and common canalicular obstruction. Management of failed DCR is mainly surgical, although some patients may opt for observation. Revision via either endoscopic or external approach achieves relatively high success rates with outcomes slightly more favorable for EN-DCR. Laser-assisted revision EN-DCR is a less traumatic alternative, particularly useful for membranous obstruction at the internal ostium. It is proven that adjunctive mitomycin-C (MMC) can help to enhance the success of revision cases. Silicone tube placement may be considered, especially in the presence of common canalicular obstruction. Balloon dacryoplasty, in highly selected patients, can also achieve good results. Appropriate assessment to identify the cause of DCR failure is essential to determine the preferred surgical approach for revision and to optimize the clinical outcome.


Dacryocystorhinostomy Revision dacryocystorhinostomy Nasolacrimal duct obstruction Endonasal Endoscopic revision Ostium fibrosis Mitomycin Dacryoplasty Silicone intubation Sump 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Emmy Y. Li
    • 1
  1. 1.Department of OphthalmologyHong Kong Eye HospitalKowloon CityHong Kong

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