Revision Endoscopic Dacryocystorhinostomy and Conjunctivodacryocystorhinostomy

Abstract: Nasolacrimal duct obstruction is commonly managed through dacryrocysorhinostomy (DCR), either through an external or endoscopic approach. Historically, the external approach was thought to have a higher success rate than the endoscopic approach. However, the literature now suggests that the endoscopic approach has comparable success with many advantages, such as avoidance of a cutaneous incision, preservation of the orbicularis oculi pump function, decreased operative time, and the ability to address concomitant intranasal pathology that may be contributing to the nasolacrimal duct obstruction, such as septal deviation or nasal polyposis. Despite the overall high success rate of both external and endoscopic DCR, there is an approximately 10% failure rate reported in the literature. These failures may be secondary to a variety of causes, such as inappropriate osteotomies, scarring, nasal pathology, functional failure, or proximal stenosis of the canalicular system. When failure occurs, revision endoscopic DCR or conjunctivodacryocystorhinostomy are important tools to readdress patient symptoms. When performed, meticulous surgical technique combined with a thorough knowledge of the anatomy of the nasolacrimal system is essential to optimize success.