Removal of an Intraoperative Iatrogenic Intranasal Metallic Foreign Body During External Dacryocystorhinostomy.

External dacryocystorhinostomy (DCR) is a widely performed and effective surgical technique for the management of nasolacrimal duct obstruction. Although generally safe, rare intraoperative complications may occur, particularly in anatomically challenging patients. We report the case of a young male patient who underwent external DCR and developed a rare intraoperative complication: the tip of a Kerrison punch broke off during osteotomy and became lodged in the nasal cavity. The metallic fragment was identified intraoperatively and successfully retrieved with forceps. This case underscores the importance of recognizing patient-specific anatomic factors, the mechanical limitations of surgical instruments in dense bony structures, and the potential value of tactile feedback and preoperative imaging in preventing such events. Surgical video footage and intraoperative images are provided to illustrate the complication and its resolution. To our knowledge, this is the first case report documenting punch breakage and intraoperative retrieval of a metallic foreign body during external DCR.