Lacrimal surgery: Glorious past, exciting present era and the audacity of hope for a brilliant future.

The evolution of lacrimal disorders and its management amply exemplifies the above stated quote of the 20th century British philosopher Bertrand Russell. Lacrimal surgeries have been a subject of discussion in antiquity with the earliest documented reference being a lacrimal sac incision in the ‘Code of Hammurabi’ in 2250 BC. The past which appears glorious today had once traveled through many tough terrains in ancient times nurtured by the Egyptians (Ebers Papyrus – 1500 BC), the Greeks (Hippocrates and Celcus – 25 BC) and the Romans (Galen – 200 AD). The Arabians chipped in between with their contributions from Ibn Sina and Al Razi in the medieval times. The Modern Dacryology was given impetus with the hallmark anatomical works of Giovanni Morgagni (1682–1771) and Johann Zinn (1727–1759) and equally by the influential lacrimal treatises by Percival Pott (1714– 1788) and Johann Schmidt (1759–1809). ‘Men love to wonder and that is the seed of science’, said the famous 19th century American poet, Ralph Waldo Emerson. Lacrimal surgeries have undergone a sea change in the last two centuries. The original Woolhouse technique (1724) of dacryocystectomy underwent numerous changes in techniques and approaches to the present age but with progressively lesser indications. The external dacyrocystorhinostomy (DCR) had a steeper evolution for obvious reasons from the times when Addeo Toti (1904) first described it to the current day practice with various incisions and lacrimal sac implants. With the introduction of rigid endoscopy and better view, endonasal dacyrocystorhinostomy showed a steep resurgence into the practice, more than a century after its original description failed to gain wider acceptance. Endocanalicular laser DCR, however till the present date has failed to gain widespread acceptance despite numerous modifications since its introduction to Dacryology by Levin and Stormogipson in 1992. Likewise was the journey of trans-conjunctival DCR (CDCR), which evolved into endoscopic and lesser invasive approaches along with numerous Jones tube modifications. Balloon dacryoplasty has evolved mostly in terms of indications rather than instrumentation or techniques. The present era of lacrimal practice is both exciting and at the same time challenging. The state of art equipments including high definition endoscopic systems, diagnostic and therapeutic dacryoendoscopy and higher resolution yet