Endoscopic dacryocystorhinostomy (EDCR) – A single group experience in an evolving technique and a review of literature

Abstract

Introduction: Endoscopic dacrocystorhinostomy (EDCR) is increasingly becoming a popular method of treating distal nasolacrimal duct obstruction (NLDO) in the modern era. In this article, through literature review and personal experience, we plan to recommend a management protocol mainly concentrating on surgical technique. Secondarily, we would also like to make the case for EDCR over traditional DCR as both techniques have comparable success rates. Objective: To detail surgical technique with emphasis on evolution of surgical steps citing the literature pertaining to various methods. Methods: A literature review was carried out using keywords endoscopic DCR and dacryocystorhinostomy techniques. In a retrospective study, EDCR case data was collected concentrating on surgical methods used. The data was then analysed using the Microsoft excel statistical analysis package. Results: Details of 136 cases were assessed from the period between 2008 to 2021. 9 key surgical steps of the procedure were identified. Discussion: Highlights of recommendations include performing a ‘first look’ endoscopy before starting the surgical procedure, optional usage of the ‘light pipe’ during sac exposure, complete removal of the sac and sending it for histology, duct stenting is useful particularly in younger patients and post-operative local application of triamcinolone in prevention of granulations at the surgical site.