ENDONASAL DACRYOCYSTORHINOSTOMY - PRIMARY AND SECONDARY

An endonasal approach was used to restore lacrimal drainage in both pr imary and secondary obstructions. Patients in the primary group had a history of keloid scar formation, or wished to avoid a scar and declin ed to have surgery performed via an external approach. Patients in the secondary group had undergone one or more previous unsuccessful lacri mal drainage repairs. A fibreoptic endonasal telescope, linked to a vi deo monitor, and appropriate nasal and lacrimal instruments, were used . The approach proved highly successful, in both anatomical and functi onal terms, in each group. In the secondary group, the endonasal appro ach allowed direct visualisation and repair of both nasal and lacrimal causes of failure; this approach is our preference in this group. In the primary group, endonasal instrumentation had no advantage over a c onventional external operation, other than avoiding a scar. The applic ation of laser technology may make the endonasal approach a realistic option in primary DCRs as well.