Laser Dacryocystorhinostomy: Equipment and Workflow

What dacryocystorhinostomy is

When the nasolacrimal duct is obstructed, tears cannot drain into the nose, causing watering and recurrent infection. DCR creates an alternative opening, an ostium, between the lacrimal sac and the nasal cavity, so tears bypass the blockage.

The classic external approach uses a skin incision and removal of bone, while endonasal and transcanalicular approaches reach the sac from inside. Choice of technique belongs to the treating surgeon.

Before choosing any technique, the team should confirm the diagnosis with the usual lacrimal assessment. Equipment decisions should follow the surgical pathway your department has already defined.

Transcanalicular laser DCR: how it works

In transcanalicular laser DCR (TCL-DCR) a thin laser fibre is introduced through the canaliculus into the lacrimal sac. The laser is used to open the thin bone between sac and nose, usually with endoscopic visualisation from the nasal side, and the passage is then typically supported according to the surgeon's protocol.

No skin incision is needed, which is the main reason the technique is studied as an alternative to external DCR. How outcomes compare is for the clinical literature to judge, and this article makes no claims about success rates.

The nasal endoscope, light source and camera are as important as the laser: poor visualisation of the ostium makes the laser step harder, so assess the whole tower and not just the laser.

Endolaser DCR equipment: the 810 nm diode

The A.R.C. FOX IV 810 is a 1.53 kg diode laser with 8 W output that runs from battery or mains. A.R.C. Laser notes that this power is enough to open bony structures in TCL-DCR, and the device has a dedicated TCL-DCR function alongside its ophthalmic applications. It covers a pulse length from 100 µs to 60 s or continuous wave.

A large colour touch display shows key parameters with application-specific colour schemes. Because it comes with accessories in a carrying case, the same laser can serve oculoplastic lists, glaucoma and retina work, which can improve utilisation. For a broader look at the device see the FOX IV 810 overview.

• 810 nm diode, 8 W output power.
• Battery or mains operation, 1.53 kg.
• Dedicated TCL-DCR function and colour touch display.
• Also supports µCPC and retinal treatments.

Laser DCR versus external DCR: neutral criteria

Compare the approaches on equipment and workflow rather than slogans: need for a nasal endoscope and camera, setup time, instrument cost, operating-room time, anaesthesia plan, skills required and your surgeons' training. The surgeon decides which technique is appropriate for each patient.

If your department also uses a CO2 and fibre system for ENT work, note that the CO2 DUO3 Concept lists flexible probes for middle-ear, laryngeal and DCR work with its fibre-guided second wavelength.

Think also about disposables and training: fibre handling, protective measures for the nasal mucosa and the learning curve all affect the true cost of introducing laser DCR into a department.

Safety and next steps

The laser is a Class 4 device, so apply controlled access, eyewear for 810 nm for everyone present and a clear footswitch discipline. Check fibre integrity before each case and record settings. Our medical laser safety guide covers room measures.

Beckfinity can arrange a demonstration of the FOX IV 810 for your oculoplastic or ENT team. Request a quote or consultation, and confirm current device registration requirements with the relevant UAE authorities.