Is an endoscopic approach superior to external dacryocystorhinostomy for nasolacrimal obstruction?

BACKGROUND Nasolacrimal duct obstruction is caused by a variety of acquired and congenital etiologies. The standard treatment is dacryocystorhinostomy (DCR), with the gold standard being the external DCR. Since the advent of the nasal endoscope, the transnasal endoscopic DCR has gained popularity and has several advantages over the external approach. Some potential advantages include the avoidance of a cutaneous scar, direct access to the rhinostomy site, the ability to inspect the intranasal anatomy at the time of surgery, the avoidance of disruption of the medial canthal anatomy and its role in the function of the nasolacrimal system, shorter operative time, and shorter postoperative recovery. Despite these advantages, external DCR is often cited as having a higher success rates when compared with the endoscopic approach. This article reviews some of the evidence regarding the success rates of the external DCR and the endoscopic DCR.