Dacryoendoscopy: Historical development, philosophical foundation, and clinical perspective

Dacryoendoscopy is valuable for managing epiphora, enabling direct visualization of the lacrimal outflow system. Notably, dacryoendoscopy enhances diagnostic precision and facilitates minimally invasive treatment. Over the past three decades, its evolution has fostered a deeper understanding of endoluminal pathology, refined recanalization techniques, and expanded therapeutic indications across age groups. Importantly, dacryoendoscopy represents not only technical refinement but also a conceptual shift - from blind intervention to anatomy-based diagnosis and management. This shift reflects a deeper surgical philosophy, that visualization must precede intervention, and that humility toward unseen structures is crucial for true minimally invasive practice. This narrative review explores the device design philosophy, terminology, and clinical use of dacryoendoscopy, focusing on the Bent group's contributions and the emergence of conservative minimally invasive lacrimal surgery, which emphasizes mucosal preservation and is specifically suited for pediatric cases. The Bent probe endoscopes, originating in Japan, have become the most widely used devices in Asia. Moreover, false passage was illustrated in relation to the duct lumen remnant within fibrous blockage, and key techniques, including sheath-guided endoscopic probing and sheath-guided intubation, were reviewed. Regardless of these advances, challenges such as long-term deterioration of surgical outcomes and the distant goal of mucosal regeneration persist. Relevant literature was identified through a nonsystematic search of PubMed and Ichushi-Web, using the keywords "dacryoendoscopy," "nasolacrimal duct," and "false passage," covering publications from 1995 to 2025.