Abstract
External dacryocystorhinostomy (DCR) was originally described in 1904 by Toti and is considered the criterion standard of lacrimal bypass surgeries. Success rates greater than 90% are common with this technique, but disadvantages, such as skin incision and disruption of the medial canthal ligament causing dysfunction of the lacrimal pump, have led to the evolution of endonasal endoscopic DCR. Several studies have shown endoscopic DCR to have comparable surgical outcome to external DCR and thus, owing to its advantages of being cosmetically more appealing, and less hurtful to the lacrimal pump system, it appears that endoscopic DCR may become the gold standard of treating epiphora and/or dacryocystitis in the future. The anatomy of the lacrimal system, the surgical technique of endonasal endoscopic DCR and several important issues regarding endoscopic DCR, such as the use of mitomycin-C, the need for silicone intubation and a comparison between external and endoscopic DCR, will be discussed.
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