Lacrimal Videos

This narrated video demonstrates the excision of an accessory lacrimal sinus or fistula and the insertion of a mini Monoka stent to protect the normal canaliculus. It discusses the different surgical options for this rare condition.   Voiceover This procedure is being done under the operating microscope to aid visualisation. The normal punctum and canaliculus […]

This narrated video demonstrates the endoscopic insertion of O’Donoghue nasolacrimal stents into a patient whose DCR has failed because of internal ostium fibrosis.   Voiceover Text: O’Donoghue stents for internal ostium fibrosis DCR failure DCR failure is typically from fibrosis over the external ostium. However, sometimes and in some series in as many of 50% […]

This narrated video demonstrates the formation of lacrimal sac and nasal mucosal flaps in endo DCR and reviews the different instruments that can be used for these steps of endo DCR and the way that the flaps should sit after they have been formed and opened out. Voiceover Text   Forming anterior and posterior lacrimal […]

This narrated video focuses on the challenges of and surgical technique for paediatric endoscopic DCR surgery. DCR is sometimes required for paediatric congenital or acquired nasolacrimal duct obstruction. Paediatric Endoscopic and external DCR have similar success rates of around 83-96%. The anatomy and technique of endo DCR in general is explored in more detail in […]

This narrated video demonstrates a canaliculotomy for canaliculitis with removal of multiple casts. It also contains teaching slides exploring the aetiology and management of canaliculitis and footage of the use of dacyroendoscopy for the management of canaliculitis. This video was produced by Dr Huw Oliphant

This narrated video demonstrates the endoscopically assisted insertion of the Ritleng bicanalicular nasolacrimal stent. It explores the technique of insertion using the Ritleng introducer and how to secure the knot in the nasal cavity. It also briefly reviews the anatomical location of the terminal end of the nasolacrimal duct under the inferior turbinate.

This narrated video demonstrates techniques for managing a narrow nasal space in endoscopic DCR. It shows how to use instruments to increase the nasal cavity space and access to the region overlying the lacrimal sac and briefly shows septoplasty surgery.

This narrated video demonstrates a modified endoscopic DCR and Lester Jones lacrimal bypass tube insertion, which is also known as conjunctivodacryocystorhinostomy. The modified endoscopic DCR has a nasal mucosal window instead of a flap and a smaller rhinostomy that may provide better bony support for the tube.

This narrated video shows a powered endoscopic DCR procedure. It explores variations in technique, including whether to tube or not and discusses the role of the diamond burr in endo DCR surgery

This narrated video demonstrates the nasal cavity surface anatomy for endoscopic DCR surgery, highlighting the location of the incision and the underlying lacrimal sac and briefly reviewing structures such as the middle turbinate, the axilla and the uncinate bone.

This narrated video demonstrates external DCR surgery. It discusses the surgical technique and anatomy.

This narrated video demonstrates the important anatomy of the agger nasi air cell and the vertical portion of the uncinate bone that is relevant to dacryocystorhinostomy. These structures are clearly seen during endonasal DCR, but are external DCR surgeons should also have an understanding of their anatomy.

This narrated video demonstrates dacryoendoscopy. It has been produced and provided by Machida Company, Japan. It should be noted that the video has been compressed and image quality is likely to be higher in full resolution.

This narrated video demonstrates a endoscopic redo DCR in which a large amount of extra bone requires removal.

This narrated video demonstrates the creation of the nasal mucosa flap during endo DCR surgery and discusses the dimensions of the flap with respect to the location of the underlying frontal process and lacrimal sac

This video demonstrates a lacrimal sac mucocele seen during endo DCR surgery

This narrated video demonstrates damage to the lacrimal sac during drilling of the frontal process with the DCR burr.

This narrated video demonstrates lacrimal sac dacryoliths being exposed and removed during endoscopic DCR surgery and discusses their presence, frequency and constitution.

This narrated video demonstrates the removal of the lacrimal bone during endo DCR.

This narrated video demonstrates infracture of the inferior turbinate. This procedure is utilised for visualising the terminal end of the nasolacrimal duct and the correct passage of a nasolacrimal stent

This narrated video demonstrates lacrimal sac opening during endo DCR surgery. This patient has a very thin walled lacrimal sac which tears during opening highlighting the need for great care at this stage of the operation.

This narrated video demonstrates an endoscopic DCR in which the shallow frontal process of the maxilla and posterior suture line with the lacrimal bone makes adequately sized ostium osteotomy formation with the rongeur impossible. The DCR burr is used to create the majority of the ostium highlighting the need for this instrument in endo DCR […]

This video demonstrates  dacryoendoscopic guided nasolacrimal stenting. A very fine gauge endoscope is used first to visualise the drainage system and then to stenting is performed with visualisation throughout the procedure.

This video demonstrates dacryoendoscopy. A very fine gauge endoscope (0.8 – 1.1mm) is passed down the canaliculus to visualise the nasolacrimal drainage system. The video shows the procedure being used in a range of patients to demonstrate the normal appearance as well as pathological findings such as canalicular and nasolacrimal obstructions, mucus in the lacrimal […]

This narrated video demonstrates a nasolacrimal stenting procedure and shows how easily damage can be caused to the terminal end of the nasolacrimal duct.

This narrated video demonstrates the repair of a lower lid canalicular laceration using a mini-Monoka stent.

The narrated video demonstrates the insertion of a Lester Jones lacrimal bypass tube in a patient who has previously had a medial canthal tumour excision. Jones tubes are challenging in these circumstances as they frequently migrate inwards. We explore the possible locations that the tube can be sited to try and improve stability.

This video demonstrates a modified DCR and Lester Jones tube insertion. The DCR has a smaller mucosal window and osteotomy than normal, which may help secure the Jones tube.

This video shows the endoscopic revision of a patient with late failure of an endoscopic DCR. At first glance the ostium appears large and patent. However, on closer endoscopic examination there is a fold within the lacrimal sac. This fold is probably a band of scar tissue. The fold is cut and O’Donoghue tubes placed.

This narrated video demonstrates the insertion of a Lester Jones tube in a patient who has previously had a DCR. This video explores the possible medial canthal locations for the mouth of the Jones tube

This video demonstrates functional endoscopic sinus surgery in a patient with invasive aspergillosis. The ethmoid and sphenoid sinuses are cleared out and optic canal in the lateral wall of the sphenoid sinus is decompressed.

This video demonstrates a modified endo DCR and Lester Jones tube lacrimal drainage tube insertion. The DCR has a smaller ostium and no flaps. This patient has had previous medial canthal tumour excision surgery resulting in medial ankyloblepharon. This is divided prior to insertion of the Jones tube. The lack of medial canthal support can […]

This narrated video of a section of an endonasal DCR demonstrates anatomical variation of the location of the suture line between the frontal process of the maxillary bone and the lacrimal bone. This case shows a posteriorly located suture line, which can make access more challenging.

This video demonstrates the insertion of Crawford tubes to stent the nasolacrimal system

This video demonstrates a punctoplasty using the ‘3-snip’ procedure to widen the punctum for cases of punctal stenosis

This patient had an initially successful endoscopic DCR, but developed recurrent symptoms. The video demonstrates  large and well-formed external ostium, but an internal ostium that has become occluded by a fibrotic membrane. The occlusion is carefully overcome and O’Donoghue tubes place to try to maintain patency.

DCR Equipment DCR Patient and Surgeon Position

Middle Turbinate Images

Post-Operative DCR Ostiums Post-operative adhesions

This video shows the use of the retinal light pipe in the canaliculus to illuminate the lacrimal sac to help delineate the nasal anatomy in a patient who has had extensive previous FESS surgery

This video demonstrates the opening of a thick walled lacrimal sac in endoscopic DCR. Such sacs, can be challenging to incise, and incision can result in shelving of the sac wall, or damage to the common canaliculus. In this video you will see the sac delicately being opened in layers

This narrated video demonstrates the use of monopolar diathermy to cauterise haemorrhage during endoscopic DCR

This video demonstrates the identification of middle turbinate concha bullosa on a CT scan and its endoscopic resection

This video demonstrates the insertion of autostable canalicular stents into a patient who has had previously had a DCR

This narrated video demonstrates a very challenging endoscopic redo DCR and highlights some of the potential challenges in these cases.

This video demonstrates an endo DCR being performed for a patient who developed nasolacrimal duct obstruction secondary to FESS surgery. The middle turbinate is absent and the inferior portion of the maxillary process of the frontal bone has been removed, probably with the lower half of the nasolacrimal duct. In such cases the anatomical landmarks are […]

This video demonstrates the retinal endoilluminator being used to transilluminate the lacrimal sac, clearly showing the full extent of the sac. This can be particularly useful when the location or dimensions of the sac are uncertain, for example in redo DCR surgery or if the internal nasal anatomy has been distorted by previous surgery.

A narrated video demonstrating a medially migrated Lester Jones tube being removed. This patient had had a medial canthal tumour excised with loss of the canalicular apparatus. A Lester Jones tube had been inserted to combat the epiphora. However, the tube migrated medially because of the lack of medial canthal support from the tumour excision […]