DACRYOCYSTORHINOSTOMY (DCR) IS A straightforward operation in termsof anatomic goals: the surgery is designed to bypass a blocked nasolacrimalduct by creating a fistula that allows the internal common punctum to communicatedirectly into the nasal vault through the lateral nasal wall (Figure 1). To accomplish this redirection of lacrimal drainage,tissue must be removed from the conjoined medial lacrimal sac and lateralnasal wall. Removing the tissue is the easy part, and there is no reason thata skilled surgeon with the right tools who is familiar with the regional anatomy(and its many variations) cannot remove the identical tissue from either thetransnasal or the external approach.
Goldberg RA. Endonasal DacryocystorhinostomyIs It Really Less Successful?. Arch Ophthalmol. 2004;122(1):108-110. doi:10.1001/archopht.122.1.108