Subciliary Dacryocystorhinostomy

Abstract

The surgical success rate of an external approach DCR is high; however, the inevitable downside of ex-DCR has been an external skin scar, which has led to the evolution of endonasal and several other non-incisional techniques. The eyelid subciliary incision is an established approach for several orbital and eyelid procedures and is known to provide excellent cosmesis [1–3]. A 10–15 mm subciliary incision is placed along the medial half of lower eyelid, reaching up to the medial canthus. The incision is placed 1–2 mm below the lash line (subciliary) and not within the eyelid crease. It extends from the punctum medially, to mid-pupillary line laterally. Subcutaneous dissection is then carried out inferomedially, to reach the anterior lacrimal crest and subsequent surgery is like that of an external DCR. In a series on subciliary DCR, at a mean post-operative follow-up of 29 weeks (range 6–72 weeks), the objective grading reported 47% of the scars to be invisible (grade 0) and 88.2% to have invisible to minimally visible (grade 0–1) scars [1]. The subjective grading by the patient reported 88% of the scars to be invisible (grade 0) and 100% scars to be invisible or minimally visible (grade 0–1) [1]. Hence subciliary approach provided excellent cosmetic outcomes while retaining both access and success of an external DCR.