title: [Treatment of nasolacrimal duct obstruction from the otorhinolaryngologist's perspective].
abstract: BACKGROUND
  Epiphora is the classic symptom of nasolacrimal duct obstruction, particularly among elderly people. Dacryocystorhinostomy (DCR) via external (Toti) and endonasal (West) approaches are well-established surgical treatments.
  
  
  OBJECTIVE
  The aim of the present article is to describe the etiology and diagnostics of nasolacrimal duct obstruction. Furthermore, treatment modalities are discussed according to the current literature, with particular consideration of the otorhinolaryngologist's perspective.
  
  
  METHODS
  A search of the current literature focused on the past 5 years was performed in PubMed.
  
  
  RESULTS
  Several retrospective and prospective randomized studies describe the external and endonasal DCR approaches as safe surgical procedures, with high success rates of around 90 %. The endoscope is standardly used for visualization during the endonasal approach. Powered instruments such as diamond drills enable generation of a large rhinostomy, even in very hard bone. The application of silicone stents does not confer a significant additional advantage in terms of postoperative success rates.
  
  
  CONCLUSIONS
  DCR is a safe surgical procedure with high success rates. It can be strongly recommended for patients suffering from intra- or post-saccular nasolacrimal duct obstruction. Furthermore, the external and endonasal approaches (according to Toti and West, respectively) are comparable techniques. The use of silicone stents is indicated only in special cases.
authors.affiliation: Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland. christian.ginzkey@med.uni-rostock.de.
authors.forename: C
authors.initials: C
authors.lastname: Ginzkey
authors.affiliation: Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Doberaner Straße 137-139, 18057, Rostock, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Mlynski
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D003608:Dacryocystorhinostomy / Q000295:instrumentation / Q000379:methods*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis* / Q000628:therapy*; D009301:Nasolacrimal Duct / Q000601:surgery*; D016896:Treatment Outcome
keywords: Dacryocystorhinostomy; Lacrimal apparatus; endonasal approach; nasolacrimal duct obstruction; silicone stents