Abdulrahman Hama Amin Hussein a, Sakar Abdulkarim Nidhamalddin b, and Sanoor Qader Mahmood b 

a Shahid Dr. Aso Teaching Eye Hospital.  
b Shahid Dr. Aso Teaching Eye Hospital. 

Submitted: 19/3/2019; Accepted: 29/7/2019; Published: 21/9/2019



Despite the long-time passed since the beginning of using dacryocystorhinostomy (DCR) for the treatment of nasolacrimal duct obstruction, it still has the highest success rate among the other surgical procedures used for the treatment of the same condition that is why it is still widely accepted and used procedure.


To evaluate the outcome of External-DCR by using manipulated surgical technique in creating anterior flap without posterior flap.

Patients and Methods

A retrospective review of patients who underwent External DCR between Sep. 2012 to Feb. 2014 at Shahid Dr. Aso Teaching Eye hospital in Sulaimani city which was performed by a single surgeon. The data of 65 patients were analyzed, all with the chief complaint of watering eye and mucocele. A U-shaped manner mucosal incision was done to create enough size anterior flap without posterior flap, after follow-up of about two years’, postoperative success was defined objectively by irrigation of the puncta without regurgitation and subjectively by patient satisfaction with the absence of epiphora or mucocele. Ethical consideration of the risks and benefits of the procedure was observed for each individual patient.


A 69 External-DCR were performed on 65 patients, of which 53 were female and 12 were males between the age of 17 and 64, all with the complaint of watering eye and mucocele. After follow up period of two years the overall success rate was 96.9%. Each individual factor like age, sex, IOP and presence of other ocular conditions were assessed against the outcome in all of them, the correlation was not significant (value > 0.05) in all instances. That makes the procedure employed the sole factor in this high success rate of the outcome. 


Creating only anterior anastomosis is technically simpler, easier, less time consuming and does not negatively influence the outcome of External-DCR surgery, this procedure demonstrates higher success rate comparable to that of the conventional method in the literature, so we conclude that the procedure can be implemented as a standard technique for external DCR.


External DCR, Anterior flap, Mucocele.