To report the technique and results of a modified external dacryocystorhinostomy procedure (Ext-DCR) and to assess the reliability of air bubble test for the success of Ext-DCR.

In a retrospective interventional case series, 45 patients (50 procedures) with nasolacrimal duct obstruction (NLDO) were included. The size of incision was gradually decreased and surgical instruments were changed to fit the aim of using a 5-mm incision for Ext-DCR. Silicone tube was inserted in all and removed around 6 weeks after the operation. Functional success was defined as no symptom or just excess tear in the cold weather and anatomical success as free irrigation at last follow up time (at least 6 months) when air bubble test (ABT) was performed and patients’ satisfaction was scored.

Mean age and follow up were 52.3 years and 16.8 months, respectively. There were 8 reoperations. Procedures were performed either under general (30) or local (20) anesthesia by one surgeon (MBK). Associated canalicular stenosis was found in 14 cases. Anatomical and functional success was 98% and 94%, respectively. Canalicular stenosis was the only variable which significantly (P<0.05) decreased the anatomical (75%) and functional (50%) success rate. Wound elongation (up to 8 mm) was observed in three cases. Mean VAS for the appearance of incision was 98.8 (95-100). ABT showed a sensitivity 78.7% of and specificity of 100%.

Minimum incision (5 mm) no skin suture Ext-DCR offers a high patients’ satisfaction and success (anatomical and functional). Positive ABT indicated no failure after Ext-DCR in this series.