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Back to the Future in the Evolution of Dacryocystorhinostomy Surgery: The Internal Dacryocystorhinostomy

Ross S Benger

Over time, the success rates in Dacryocystorhinostomy (DCR) performed with an endonasal approach have improved to approximate those achieved with an external approach. This applies to a non-endoscopic approach using mechanical instruments alone as in an external DCR, as well as an approach using additional newly developed and more technologically complex instruments including a rigid endoscope. Each endonasal approach can be described as an “internal” one in contrast to the external one, and the author has found this terminology helpful in discussing with patients the differences between a DCR being performed from the inside instead of the outside of the nostril. While much attention has been given to endoscope use for endonasal DCR techniques, the equipment necessary is not universally available. The non-endoscopic technique has received less attention, but it offers the equally successful alternative.