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Nuzzi R., Minazzi G. L., Donati S.
External dacryocystorhinostomy (DCR) is the traditional treatment for nasolacrimal duct stenosis. In spite of its high success rate, this technique has limits and drawbacks. Endoscopic lacrimal surgery (ELS) has been developed over the last few years in response to this challenge. This study illustrates the possible applications and the differences between the two operating techniques. A complete overview of the anatomy and physiology of the excretory lacrimal duct will help to provide a better understanding of the diagnostic and clinical goals of DRC and ELS. The study is focused on the lower apparatus (lacrimal sac and nasolacrimal duct) in which obstructive pathology is primarily represented by dacryostenoses. We have classified the latter according to etiology to clarify the possibilities of surgery using the two aforesaid techniques. These are based on three main clinical forms: simple lacrimation, chronic dacryocystitis and acute dacryocystitis, depending on the evolution of the disease. The success rates of DCR and ELS are comparable at present, but the surgical method is totally different. External DCR involves access to the lacrimal sac using a cutaneous route; this technique has remained unchanged for many years and the method is widely recognised. ELS is based on the use of a flexible microendoscope inserted through the upper or lower lacrimal punctum as required and the nasolacrimal apparatus is then examined in reverse (by pulling back the optic fibre). ELS does not produce significant postoperative complications, but it offers many advantages compared with external DCR, namely anatomic integrity, the possibility of easy repeatability and improved patient satisfaction.