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Updated: Apr 24, 2026
Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Tear Trough Incision for External Dacryocystorhinostomy.
Brett W Davies1, Michael S McCracken, Michael J Hawes
1*Oculofacial Plastic and Orbital Surgery, University of Colorado Hospital, Aurora, Colorado; †McCracken Eye and Face Institute, Parker, Colorado; ‡Denver, Colorado; §Texas Oculoplastic Consultants, Austin, Texas; and ‖Colorado Springs, Colorado, U.S.A.
External dacryocystorhinostomy (exDCR) scars are nearly invisible to patients when the incision is placed in the tear trough. This technique significantly improves scar appearance following the surgical procedure for nasolacrimal duct obstruction.
Area of Science:
- Ophthalmology
- Plastic Surgery
Background:
- Scar formation is a common concern after external dacryocystorhinostomy (exDCR).
- The location of the skin incision can influence scar visibility and patient satisfaction.
Purpose of the Study:
- To evaluate the cosmetic outcome of exDCR with a skin incision strategically placed within the tear trough.
- To assess patient and surgeon-reported scar appearance after this surgical approach.
Main Methods:
- A prospective, multicenter study included patients undergoing exDCR with a 10-15 mm incision in the tear trough.
- Patients and three independent surgeons graded scar visibility at 3 months postoperatively using a standardized scale.
- Functional success was also assessed by patient-reported symptom resolution or improvement.
Main Results:
- 95.8% of patients reported symptom improvement or resolution.
- The average patient scar grade was 0.21, with 83.3% grading the scar as invisible.
- Surgeons graded the average scar as 0.99, with 25.5% considered invisible and only 3.7% very visible.
Conclusions:
- Placing the exDCR incision in the tear trough results in minimally visible scars to surgeons.
- Crucially, this technique renders the scar nearly invisible to patients, enhancing cosmetic outcomes.
