[Dacryocystorhinostomy - state of the art, indications, results]

In the ophthalmological literature external dacryocystorhinostomy (DCR) is considered the gold standard for the treatment of lacrimal duct stenoses. Rhinologists, on the other hand, favour the endonasal approach.

On the basis of an extensive review of the literature and our own longstanding experience we present an overview of the causes, the necessary diagnostic procedures and the surgical management of lacrimal duct stenosis. The outcomes of the two operative approaches are compared and special operative techniques and aids such as the use of laser, endoscopic dacryoplasty, silicone stenting, silicone cones with lacrimal duct stenting and the use of mitomycin C are discussed.

The results published for endonasal DCR are slightly worse than those for the external operation. The success rates are around 90 %. Laser-assisted DCR and endoscopic dacryoplasty do not currently appear to yield better results than the conventional methods. Silicone stenting is not necessary in conventional endonasal DCR except in the case of presaccal stenosis. There are no established indications or treatment regimens for mitomycin C to date. Postoperative care after endonasal DCR should consist in the removal of fibrin, crusts and granulations and the administration of eye drops (antibiotic + cortisone) and nasal steroids.

With appropriate operative technique and in experienced hands, the success rates of endonasal DCR are practically equal to those of the classical external approach. Major advantages of the endonasal approach are shorter operation times, lower complication rates and reduced patient morbidity. Neither silicone stenting nor the application of mitomycin C are routinely indicated. Laser-assisted techniques do not currently appear to improve results. Appropriate postoperative care is essential to prevent endonasal synechiae and subsequent recurrences.