Modified Endoscopic Dacryocystorhinostomy Using the Middle Uncinate Process Approach

PURPOSE: Endoscopic dacryocystorhinostomy (EDCR) is advantageous in that it avoids facial scar formation, does not damage the medial canthus ligament, and recovers quickly. The main purpose of EDCR is to establish a fistula large enough to completely expose the lacrimal sac and avoid complications. Accurate location of lacrimal sac and complete opening of lacrimal sac are the keys to successful operation. However, due to the individual differences in the size of the lacrimal sac and the anatomical structure of the nasal cavity, it is difficult to determine the location of the lacrimal sac during the operation. Most patients need to place dilatation tubes after operation, which may lead to some defects. To explore the clinical effects of modified dacryocystorhinostomy using nasal endoscopy through the middle uncinate process approach for the treatment of chronic dacryocystitis and nasolacrimal duct obstruction. METHODS: Sixty-nine patients (71 eyes) with chronic dacryocystitis and nasolacrimal duct obstruction underwent modified dacryocystorhinostomy using nasal endoscopy. Modified methods included changes in surgical approach, incision of the anterior wall of the lacrimal sac, and treatment of adherent mucosa. RESULTS: In all 71 eyes, no serious complications occurred. The anatomical success rate was 93.0% (66/71) and the symptomatic success rate was 97.2% (69/71). None of the patients underwent conversion to an open method. CONCLUSION: Modified dacryocystorhinostomy using nasal endoscopy is advantageous in terms of shorter operation time, accurate dacryocystorhinostomy location, less bleeding, relatively simple operation, no requirement for dilation tube insertion, and better effects than conventional dacryocystorhinostomy using nasal endoscopy. Modified dacryocystorhinostomy is a safer and more effective method to treat chronic dacryocystitis-nasolacrimal duct obstruction.