Abstract:Endoscopic dacryocystorhinostomy(En-DCR)alleviates the clinical symptoms caused by lacrimal drainage obstruction by creating a new anatomical pathway between the lacrimal sac and the nasal cavity. Whether mechanical support of the anastomotic cavity is necessary during En-DCR, as well as the optimal mode of support, remains a subject of ongoing clinical debate. Current evidence suggests that routine primary En-DCR does not require mechanical support of theanastomosis. However, in patients with complex conditions—such as high-level or extensive obstruction, a small lacrimal sac, traumatic lacrimal injury, or those undergoing revision surgery—lacrimal stenting is generally recommended to maintain patency of the surgical cavity. In addition, selective nasal cavity support may be considered for patients at high risk of postoperative bleeding, with a large bony ostium, extensive mucosal injury, or those undergoing concomitant intranasal or endoscopic sinus procedures. This review addresses En-DCR from three perspectives: procedures without mechanical support, selective lacrimal pathway support, and selective nasal cavity support. It summarizes recent advances in the individualized selection of mechanical support strategies for En-DCR, analyzes their clinical outcomes and existing controversies, and aims to provide a theoretical reference for clinical practice to help optimize treatment strategies for lacrimal drainage disorders.
