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Endoscopic Dacryocystorhinostomy(DCR)/Epiphora
Tearing results from either excess lacrimation or impairment of drainage, also known as
epiphora. Epiphora can be unilateral, bilateral, constant, or intermittent. It can be associated with
many conditions including, midfacial trauma, sinus disease or sinus surgery, as well as systemic
disease. Several diagnostic tests can be used for diagnosis of nasolacrimal duct obstruction: the
dye disappearance test, lacrimal system irrigation/probing, scintigraphy, and contrast
dacryocystography. The definitive treatment of this difficult problem is dacyrocystorhinostomy
(DCR).

Historically, surgery for nasolacrimal duct obstruction mainly involved external techniques. In
1989, endoscopic dacryocystorhinostomy (DCR) was first described in by Mcdonogh and
Meiring. With continued understanding of endoscopic lacrimal anatomy and advancements in
specialized instrumentation, endoscopic DCR now yields results that are comparable to external
procedures.

The endoscopic DCR technique begins with identification of important anatomical landmarks.
Mucosal incisions and flaps are fashioned endoscopically, after which the bone overlying the
lacrimal sac is removed with a drill. After lacrimal sac has been exposed, probes are used to
dilate the inferior and superior punctum in the corner of the eye. Silastic stents are then passed
within the lacrimal apparatus and secured intranasaly. The stents may be left in place for variable
amounts of time depending on the etiology of the epiphora. Complications of endoscopic DCR
are rare, but may include surgical failure, chronic sinusitis, epistaxsis, CSF leak, and orbital
injury. Success rates for endoscopic DCR vs. external approaches are equivalent.