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Endonasal Dacryocystorhinostomy (Endo-DCR)

Minimally invasive endoscopic procedure for nasolacrimal duct obstruction, creating a direct opening from the lacrimal sac into the nose to relieve epiphora and recurrent dacryocystitis.

Written by: Saygı Hospital Health Guide Editorial Board
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This content is for general information; please consult your physician for diagnosis and treatment.

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What is Endonasal Dacryocystorhinostomy (Endo-DCR)?

Nasolacrimal duct obstruction (NLDO) blocks tear flow from the puncta to the nasal cavity, causing epiphora (tearing), mucopurulent discharge, and recurrent dacryocystitis. Acquired primary NLDO is most common in middle-aged women; secondary causes include chronic dacryocystitis, trauma, sarcoidosis, granulomatosis with polyangiitis, sinus surgery, and post-radiotherapy fibrosis.

Endo-DCR uses rigid endoscopy with 0° and 30° telescopes to identify the lacrimal sac fossa, remove frontal process of the maxilla and lacrimal bone (with powered instruments or drill), incise the sac mucosa, and form a stable mucosa-to-mucosa anastomosis with the nasal lining. Silicone bicanalicular intubation may be used for 3–6 months.

Indications: chronic NLDO with epiphora, recurrent dacryocystitis, dacryocyst mucocele, failed external DCR. Contraindications: active acute dacryocystitis (treat infection first), nasal cavity tumor, severe nasal stenosis. Preoperative evaluation includes lacrimal probing/irrigation, nasal endoscopy, CT-DCG when anatomy is unclear, and culture if active infection.

Symptoms

Chronic epiphora (constant tearing), worse outdoors or with wind
Mucopurulent discharge from puncta on sac compression
Recurrent dacryocystitis (medial canthal swelling, redness, pain)
Dacryocystocele in infants and adults
Crusting at lid margin, conjunctival irritation
Failed previous balloon dacryoplasty or external DCR
Cosmetic concerns from chronic medial canthal mass

Risk Factors

Female gender, age 40–70 years
Chronic sinonasal inflammation
History of facial trauma or sinus surgery
Granulomatous diseases (sarcoidosis, GPA)
Radiotherapy to head and neck
Anatomical narrow nasolacrimal canal
Chronic punctal/canalicular stenosis

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent epiphora despite probing/irrigation — oculoplastics or rhinology referral
  • Recurrent dacryocystitis episodes — definitive surgical drainage planning
  • Dacryocystocele in newborn — prompt referral
  • Acute dacryocystitis with cellulitis or abscess — emergency drainage and antibiotics
  • Persistent symptoms after Endo-DCR — re-evaluation for revision surgery

Treatment Methods

01
Preoperative: control of acute infection with oral antibiotics (amoxicillin-clavulanate), warm compresses, lacrimal irrigation
02
Endo-DCR technique: rigid 0°/30° endoscopy, identification of axilla of middle turbinate as landmark, mucosal flap, removal of bone with Kerrison rongeur or powered drill (~10–12 mm ostium), opening of sac with sickle knife, mucosa-to-mucosa anastomosis
03
Adjuncts: silicone bicanalicular stent for 3–6 months, mitomycin-C application in revision cases or scarring tendencies
04
Postoperative care: nasal saline irrigation, topical decongestant, antibiotic-steroid ointment to canthus, oral antibiotics 5–7 days
05
Outpatient follow-up at 1, 4, 12 weeks: endoscopic ostium check, lacrimal irrigation patency, stent removal at 3–6 months
06
Success rates: 85–95% primary, 70–85% revision; complications include bleeding, ostium closure, canalicular trauma, orbital injury (rare)
07
Combined endoscopic sinus surgery if concurrent chronic rhinosinusitis or septal deviation
08
Treatment of underlying systemic disease (sarcoidosis, GPA) crucial for long-term patency

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.