Aesthetic External DCR: The Subciliary Approach

  • Milind N. Naik


External dacryocystorhinostomy (Ex-DCR) is considered as the gold standard for surgical correction of primary acquired nasolacrimal duct obstruction [1]. It can be performed safely in patients under local anesthesia, with minimal blood loss and economic cost, and has a high success rate of over 90 % in most published series [1, 2]. Despite superior success rate, the inevitable downside of Ex-DCR has been an external skin scar, which has led to the evolution of endonasal and several other nonincisional techniques [3–7]. The success rates with endonasal DCR have been reported to range from 59 to 100 % in various published series with mechanical endonasal DCR being more successful than endolaser DCR [5]. The advantages of endonasal DCR have been reported to be lack of cutaneous scar, less disruption of medial canthal anatomy or lacrimal pump function, decreased operative time, early postoperative rehabilitation, and the ability to simultaneously treat nasal pathologies [6]. However, the disadvantages of the technique include the need for specialized instruments, increased cost, familiarity with nasal anatomy, difficulty in the treatment of canalicular pathologies, need for an expert assistant, and a steep learning curve [6]. Although there have been promising advances in the field of endocanalicular and endonasal DCR surgery, the high success rate of Ex-DCR continues to be confirmed in the literature [8].


Lower Eyelid Medial Canthus Transconjunctival Approach Eyelid Crease External Dacryocystorhinostomy 
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  1. 1.
    Tarbet KJ, Custer PL. External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost. Ophthalmology. 1995;102:1065–70.PubMedCrossRefGoogle Scholar
  2. 2.
    Warren JF, Seiff SR, Kavanagh MC. Long-term results of external dacryocystorhinostomy. Ophthalmic Surg Lasers Imaging. 2005;36:446–50.PubMedGoogle Scholar
  3. 3.
    Watkins LM, Janfaza P, Rubin PA. The evolution of endonasal dacryocystorhinostomy. Surv Ophthalmol. 2003;48:73–84.PubMedCrossRefGoogle Scholar
  4. 4.
    Goldberg RA. Endonasal dacryocystorhinostomy: is it really less successful? Arch Ophthalmol. 2004;122:108–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Moore WM, Bentley CR, Olver JM. Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser. Ophthalmology. 2002;109:1575–82.PubMedCrossRefGoogle Scholar
  6. 6.
    Woog JJ, Kennedy RH, Custer PL, et al. Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2001;108:2369–77.PubMedCrossRefGoogle Scholar
  7. 7.
    Javate RM, Campomanes Jr BS, Co ND, et al. The endoscope and the radiofrequency unit in DCR surgery. Ophthal Plast Reconstr Surg. 1995;11:54–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Duffy MT. Advances in lacrimal surgery. Curr Opin Ophthalmol. 2000;11:352–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Adenis JP, Robert PY. Retrocaruncular approach to the medial orbit for dacryocystorhinostomy. Graefes Arch Clin Exp Ophthalmol. 2003;241:725–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Kaynak-Hekimhan P, Yilmaz OF. Transconjunctival dacryocystorhinostomy: scarless surgery without endoscope and laser assistance. Ophthal Plast Reconstr Surg. 2011;27:206–10.PubMedGoogle Scholar
  11. 11.
    Cokkeser Y, Evereklioglu C, Er H. Comparative external versus endoscopic dacryocystorhinostomy: results in 115 patients (130 eyes). Otolaryngol Head Neck Surg. 2000;123:488–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Sham CL, van Hasselt CA. Endoscopic terminal dacryocystorhinostomy. Laryngoscope. 2000;110:1045–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Sprekelsen MB, Barberán MT. Endoscopic dacryocystorhinostomy: surgical technique and results. Laryngoscope. 1996;106:187–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Tsirbas A, Wormald PJ. Endonasal dacryocystorhinostomy with mucosal flaps. Am J Ophthalmol. 2003;135:76–83.PubMedCrossRefGoogle Scholar
  15. 15.
    Dupuy-Dutemps B. Procédé plastique de dacryocysto-rhinostomie et ses résultats. Ann Oculistique. 1921:241–261.Google Scholar
  16. 16.
    Linberg JV. Contemporary issues in ophthalmology, vol. 5. New York: Churchill Livingstone; 1988. p. 151–67.Google Scholar
  17. 17.
    Harris GJ, Sakol PJ, Beatty RL. Relaxed skin tension line incision for dacryocystorhinostomy. Am J Ophthalmol. 1989;108:742–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Putterman AM. Eyelid incision approach to dacryocystorhinostomy facilitated with a mechanical retraction system. Am J Ophthalmol. 1994;118:672–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Kim JH, Woo KI, Chang HR. Eyelid incision for dacryocystorhinostomy in Asians. Korean J Ophthalmol. 2005;19:243–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Akaishi PM, Mano JB, Pereira IC, et al. Functional and cosmetic results of a lower eyelid crease approach for external dacryocystorhinostomy. Arq Bras Oftalmol. 2011;74:283–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Heckler FR, Songcharoen S, Sultani FA. Subciliary incision and skin-muscle eyelid flap for orbital fractures. Ann Plast Surg. 1983;10:309–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Ben Simon GJ, Molina M, Schwarcz RM, et al. External (subciliary) vs internal (transconjunctival) involutional entropion repair. Am J Ophthalmol. 2005;139:482–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Ophthalmic Plastics SurgeryL.V. Prasad Eye InstituteHyderbadIndia

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