Enhancing Endoscopic Dacryocystorhinostomy: A Novel Transethmoidal Approach to the Lacrimal Fossa

Endoscopic dacryocystorhinostomy (EE-DCR) has been established as an effective strategy for managing lower nasolacrimal duct obstructions (L-NLDOs). Although several techniques have been proposed, none have demonstrated superior outcomes. We developed a novel transethmoidal approach to the lacrimal fossa, which embodies the fundamental principles of endoscopic sinus surgery. Images and video are presented to describe the procedure and for educational purposes. Patients with unilateral L-NLDO were evaluated preoperatively (T0), at 6 months (T1), and 12 months (T2) postoperatively. Surgical success was defined as complete (patency on irrigation with symptom resolution) or anatomical (patency with persistent epiphora). Overall, surgical success was achieved in 308/365 (84.4%) patients at T1 and in 317/365 (86.9%) patients at 12 T2. At T1, 155/365 (42.47%) patients achieved complete success, and 153/365 (41.49%) anatomical success. At T2, 215/365 (58.90%) had complete success, and 102/365 (27.94%) had anatomical success. Minor complications (n = 13/365, 5.56%) were managed intraoperatively. The mean procedure duration was 37.40 ± 12.12 minutes. In our experience, this approach guaranteed favorable results and low complication rates, with reasonably short procedural times.