Background: Endoscopic dacryocystorhinostomy (End-DCR) is an operation used to treat nasolacrimal duct obstruction (NLDO). The success rate of Endo-DCR has been reported to  range from 51-97%. Several adjunctive techniques have been described to improve outcomes, including stenting, the use of mitomycin C, creating a large osteotomy using powered instruments, and preserving nasal mucosal and lacrimal flaps to reduce granulation tissue formation around the neo-stoma. 

Objective: The aim of this presentation is to help the otolaryngologists to overcome the difficulties encountered in End-DCR and improve the success rate. 

The items of presentation include: 

• Anatomical consideration in End-DCR 
• Preoperative ophthalmological assessment to confirm NLDO 
• Tips and Tricks in surgical technique of End-DCR 
• Complications 
• Causes of End-DCR failure 

Conclusion: A good understanding of the surgical anatomy of the lateral nasal wall and the lacrimal system helps overcome the challenges encountered in End-DCR. Complete exposure and marsupialization of the lacrimal sac increase the success rate of End-DCR. Creation and  preservation of nasal mucosal and lacrimal flaps may help decrease the rate of neo-stoma  closure by covering the exposed bone, thereby reducing granulation tissue formation.

TBA