Current concepts in lacrimal drainage surgery.

Dacryocystorhinostomy remains the mainstay of treatment of acquired primary and secondary obstructions of the lacrimal drainage system. The advent of the endoscope has prompted renewed interest in the intranasal or endonasal approach to fistulae formation. As results of the intranasal approach are reported, they are compared with the time-tested and effective external approach, bringing controversy to the once staid subject of lacrimal drainage surgery. Debate continues regarding the optimal timing of intervention in the treatment of congenital nasolacrimal duct obstruction. Clinical outcome analysis suggests that early office-based lacrimal probing is more cost-effective than a hospital-based procedure. Others warn that when other factors are included in the decision process, the recommended course of intervention may be different. If dacryocystorhinostomy is required in a child with congenital nasolacrimal duct obstruction, the results by an experienced surgeon are comparable with those in an adult operated on for primary acquired lacrimal obstruction.