title: Transconjunctival dacryocystorhinostomy: scarless surgery without endoscope and laser assistance.
abstract: OBJECTIVE
  To evaluate the efficacy of a novel external dacryocystorhinostomy technique with transconjunctival approach to avoid facial scarring without the use of endoscope and/or laser.
  
  
  METHODS
  In this prospective interventional case series, 25 eyes of 22 patients with epiphora due to primary nasolacrimal duct obstruction were included. Lower eyelid conjunctival inferomedial vestibular incision was used to access the lacrimal sac and nasal mucosa. Bone apertures were created with burr and rongeurs, and saccal and nasal flaps were anastomosed. Bicanalicular silicone intubation was done. Conjunctival wound edges were apposed and left unsutured. Intraoperative difficulties and complications are noted. Patients were followed up postoperatively for an average period of 11 months. Criteria for success were relief of epiphora and patency to irrigation.
  
  
  RESULTS
  In 12 (48%) eyes, the surgeries were completed without complications with the formation of both the anterior and posterior flaps. Epiphora resolved in 18 of 19 eyes (94.7%) in which transconjunctival dacryocystorhinostomy could be completed. In 7 eyes (28%), only anterior flaps could be sutured. The authors needed to convert to external dacryocystorhinostomy in 6 patients (34%) during whose surgeries the nasal mucosa could not be exposed adequately via the transconjunctival route. Epiphora and failure to irrigation started in one eye (5.3%) at the postoperative fourth month and required reoperation. No complications occurred, except granuloma formation at the conjunctival incision site in 2 eyes (10.6%) and a 1-mm-long lower eyelid margin laceration in one eye (5.3%). Epiphora resolved in the remaining 6 eyes that underwent external DCR.
  
  
  CONCLUSIONS
  Transconjunctival dacryocystorhinostomy, which is performed without endoscope and/or laser assistance, has a high success rate comparable to external DCR and does not leave a visible facial scar.
authors.affiliation: Ophthalmic Plastic and Reconstructive Surgery Department, Istanbul Beyoğglu Eye Research and Training Hospital, Galata, 34349 Istanbul, Turkey. pkaynak@gmail.com
authors.forename: Pelin
authors.initials: P
authors.lastname: Kaynak-Hekimhan
authors.forename: Omer Faruk
authors.initials: OF
authors.lastname: Yilmaz
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000517:prevention & control; D003228:Conjunctiva / Q000601:surgery; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007440:Intubation / Q000379:methods; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012826:Silicone Elastomers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012826:Silicone Elastomers