The success rates for endonasal dacryocystorhinostomy

Tsirbas and Wormald are to be congratulated on their landmark paper in lacrimal surgery describing endonasal dacryocystorhinostomy (DCR) with mucosal flaps,1 which is also known as powered endonasal DCR.2,3 Their results are seemingly impressive, with anatomical success rate of 95% and functional success rate of 89%, closely approaching those of external (transcutaneous) DCR. I have three comments that I hope will help readers who are less familiar with endonasal lacrimal surgery, put this paper into perspective. Firstly, the mucosal flaps have a greater role peroperatively than postoperatively. The large nasal mucosal flap reflected medially over the middle turbinate protects that structure peroperatively from inadvertent damage during mechanical/powered instrumentation. After the bony opening has been made (osteotomy) this flap is trimmed in the described C shape, which prevents it from flapping over the common canalicular opening and occluding it; …