Endoscopic dacryocystorhinostomy as an option for symptomatic epiphora in isolated monocanalicular obstruction

Epiphora from monocanalicular obstruction is commonly treated with canaliculoplasty, with or without dacryocystorhinostomy, or with conjunctivodacryocystorhinostomy with Jones tube placement. We describe two patients with epiphora due to isolated monocanalicular obstruction without concurrent nasolacrimal duct obstruction who underwent endoscopic dacryocystorhinostomy; both cases had previously failed canaliculoplasty, and both reported significant improvement in epiphora postoperatively. We hypothesize this is due to decreased resistance through the lacrimal drainage system allowing for increased flow through the patent canaliculus and shortened lacrimal apparatus. In patients presenting with epiphora secondary to isolated monocanalicular obstruction, endoscopic dacryocystorhinostomy may be considered in the absence of nasolacrimal duct obstruction before proceeding to conjunctivodacryocystorhinostomy and Jones tube placement.