Endoscopic surgery for lacrimal outflow obstruction is a safe and effective alternative to traditional external dacryocystorhinostomy (DCR) surgery in most patients, and offers the advantages of excellent visualization, the ability to thoroughly evaluate the location and size of the rhinostomy site, and the avoidance of a facial scar. A variety of endoscopic techniques for DCR have been described, with all focusing on the atraumatic creation of a generous bony rhinostomy on the superolateral nasal wall. Endoscopic DCR offers success rates comparable to those achieved through external approaches. Complications during DCR surgery are best avoided by precisely identifying the location of the lacrimal apparatus intranasally, using key landmarks including the maxillary line and superior middle turbinate attachment. The technical skills and instrumentation required for performing endoscopic DCR are similar to those used for routine endoscopic sinus surgery (ESS).
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