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June 2014
Background
Dacryocystorhinotomy (DCR) is a common procedure used to treat nasolacrimal duct obstruction. The modern external DCR, in which the lacrimal sac is opened directly into the nasal cavity, was first described in 1904 by Toti. Since that time, DCR techniques have evolved, including a transnasal endoscopic approach that has gained popularity in parallel with the growth of endoscopic sinus surgery. Endoscopic DCR has challenged the external approach as the gold standard for addressing mechanical nasolacrimal duct obstruction. With either method, a transcanalicular stent is typically placed at the time of surgery to maintain patency of the DCR ostium. The importance of postoperative stenting is an ongoing topic of controversy among both otolaryngologists and ophthalmologists. This article reviews the evidence regarding the impact of stenting on endoscopic DCR outcomes.
Best Practice
Endoscopic dacryocystorhinostomy is a safe and effective surgery for treatment of epiphora due to nasolacrimal duct obstruction. Based on the external DCR literature and the established practice of ophthalmologic surgeons, silicone stents have been favored with endoscopic DCR and remain widely utilized today. However, review of the current literature demonstrates comparable outcomes in endoscopic DCR whether stents are used or not. Endoscopic DCR without stenting reduces the intensity of post-operative management and avoids the potential for stent-related complications. Click here to read the full article in the Laryngoscope.