Refining the External Dacryocystorhinostomy Incision: A Landmark-Based Technique for Angular Vein Preservation

Abstract

Background: External dacryocystorhinostomy (DCR) remains the gold standard for the surgical management of primary acquired nasolacrimal duct obstruction due to its high success rate and long-term patency. Despite the advent of endonasal and transcanalicular approaches, external DCR is still widely practiced, particularly in resource-limited settings.

Objective: To describe a surgical approach to external dacryocystorhinostomy (DCR) that preserves the angular vein and minimizes intraoperative bleeding and complications.

Methods: A prospective study was conducted on 138 patients undergoing external DCR. The surgical incision was modified based on preoperative anatomical assessment of the angular vein location by Simple Calliper.

Results: Preservation of the angular vein was achieved in 100% of cases. Minimal intraoperative bleeding and no vascular complications were observed. Surgical outcomes showed high patency rates and reduced postoperative morbidity.

Conclusion: A carefully planned incision for DCR that avoids the angular vein significantly reduces complications and improves outcomes, making it a preferred technique in external DCR procedures.