Aesthetic External DCR: The Subciliary Approach

Abstract

External dacryocystorhinostomy (Ex-DCR) is considered as the gold standard for surgical correction of primary acquired nasolacrimal duct obstruction [1]. It can be performed safely in patients under local anesthesia, with minimal blood loss and economic cost, and has a high success rate of over 90 % in most published series [1, 2]. Despite superior success rate, the inevitable downside of Ex-DCR has been an external skin scar, which has led to the evolution of endonasal and several other nonincisional techniques [3–7]. The success rates with endonasal DCR have been reported to range from 59 to 100 % in various published series with mechanical endonasal DCR being more successful than endolaser DCR [5]. The advantages of endonasal DCR have been reported to be lack of cutaneous scar, less disruption of medial canthal anatomy or lacrimal pump function, decreased operative time, early postoperative rehabilitation, and the ability to simultaneously treat nasal pathologies [6]. However, the disadvantages of the technique include the need for specialized instruments, increased cost, familiarity with nasal anatomy, difficulty in the treatment of canalicular pathologies, need for an expert assistant, and a steep learning curve [6]. Although there have been promising advances in the field of endocanalicular and endonasal DCR surgery, the high success rate of Ex-DCR continues to be confirmed in the literature [8].