Subciliary Incision for External Dacryocystorhinostomy

Purpose: To report the cosmetic and functional outcomes of subciliary incision for external dacryocystorhinostomy (DCR). Methods: Prospective interventional study reporting subciliary incision to perform external DCR for primary acquired nasolacrimal duct obstruction. Successful functional outcome was defined as relief from epiphora, and patent lacrimal irrigation. Final cosmetic outcome of the scar was evaluated by subjective grading of the scar by the patient, and objective grading by the physician using high-resolution digital photographs. Results: Seventeen eyes of 16 patients (4 males) with a mean age of 41.75 years (range, 26-71) underwent subciliary approach external DCR over a period of 22 months (March 2010 to December 2011). Pre-operative diagnosis was primary acquired nasolacrimal duct obstruction in all cases. Anatomic and functional success was noted in all 17 (100%) eyes. At the final follow up, objective grading of the scar by the physician reported 47% scars to be invisible (grade 0), and 88.2% scars to be invisible or minimally visible (grade 0-1). At the final follow up, subjective scar grading by the patient reported 88% scars to be invisible (grade 0), and 100% scars to be invisible or minimally visible (grade 0-1). In 2 (11.7%) cases, the physician reported the final scar as moderately visible (grade 2). Average follow up after surgery was 29 weeks (range, 6-72 weeks). In 2 eyes (first 2 cases), the incision extended medially by 2 mm. No other surgery related complications were noted. Conclusions: Subciliary DCR provides an excellent functional cosmetic scar outcome while retaining the access and advantages of external DCR procedure. (Ophthal Plast Reconstr Surg 2012; 28: 341-345)