A Review of Diagnostic and Therapeutic Dacryoendoscopy

To provide a systematic review of the literature on diagnostic and therapeutic indications, techniques, utility, and complications of dacryoendoscopy (DEN).

The authors performed a PubMed search of articles published in English/German/Japanese/Chinese on DEN. Data captured include evolution and techniques, diagnostic utility, therapeutic interventions, outcomes, and limitations. Specific emphasis was laid on addressing the current practice patterns and existing lacunae.

Diagnostic DEN has enabled the exact localization and differentiation of mucosal edema, stenosis, strictures, and obstructions throughout the lacrimal drainage system (LDS). Guided expansion of the stenosis, laser dacryoplasty (LDP) for strictures and microdrill removal of dacryoliths (microdrill dacryoplasty [MDP]) are some of the therapeutic uses of DEN. Successful outcomes of up to 60%-70% were achieved with stenosis anywhere along the LDS with a restenosis rate of 20%. Longer segment of stenosis (>2 mm), presence of enlarged lacrimal sac, history of dacryocystitis, postsaccal stenosis, and complete obstruction were associated with poorer outcomes. Microendoscopic procedures like LDP or MDP achieve canalicular and NLD recanalization with optimal results. DEN guided-probing demonstrated high success rates in cases with an earlier failed probing. Available dacryoendoscopes allow high-quality image capture (15,000 pixels) with multiple ports for additional instrumentation and irrigation.

Dacryoendoscopic examination of canaliculus and nasolacrimal duct plays a significant role in the diagnosis and management of lacrimal disorders. Further improvements in microendoscopic techniques and instrumentation will expand its clinical usage and give impetus to minimally invasive lacrimal surgeries.Dacryoendoscopy examinations are increasingly playing a significant role in the diagnosis and therapies of lacrimal drainage disorders.