Endoscopic and external dacryocystorhinostomy (DCR) - which is better?

Long-term outcomes in primary powered endoscopic dacryocystorhinostomy

“…The main causes of failure of endoscopic DCR have been attributed to failure in locating the sac, insufficient osteotomy, inadequate sac opening, organising granulation tissue, fibrosis and bone neogenesis 20 21. The keys for successful long-term outcomes in endoscopic DCR include accurate localisation of sac, creation of a large osteotomy sufficient to expose entire lacrimal sac, complete sac marsupialisation, and a mucosa-to-mucosa apposition allowing healing by primary intention.…”

Outcomes in Primary Powered Endoscopic Dacryocystorhinostomy: Comparison between Experienced versus Less Experienced Surgeons

“…This knowledge led to the development of mechanical and powered endoscopic DCR, which has shown a consistent and comparable success rates of >95%. 1–10 The reasons that can be attributed to high success rates of powered endoscopic DCR include large osteotomy, complete exposure of sac, and a thorough mucosa-to-mucosa apposition allowing healing with primary intention. 8–9…”

Long‐term outcomes in revision powered endoscopic dacryocystorhinostomy

“…However, failures have been reported in up to 10% of the patients . The common surgical causes of failures include inability to correctly locate the sac, insufficient osteotomy, inadequate sac opening, and significant but uncorrected septal deviations and concha bullosa . Common endoscopic findings in failed cases are cicatricial ostium closures, scarred common canaliculus, obstructed distal canaliculi, organizing granulomas, and bone neogenesis .…”

“…The common surgical causes of failures include inability to correctly locate the sac, insufficient osteotomy, inadequate sac opening, and significant but uncorrected septal deviations and concha bullosa . Common endoscopic findings in failed cases are cicatricial ostium closures, scarred common canaliculus, obstructed distal canaliculi, organizing granulomas, and bone neogenesis . Reported success rates for revision DCR are typically quoted as being lower than for primary DCR, with success rates ranging from 85% to 94% in external DCR, 83% to 94% in endonasal DCR, and 67% to 83% in endocanalicular laser DCR .…”