Transcanalicular microendoscopy of the lacrimal system has brought great advantages in knowledge and our understanding of the pathophysiology of the lacrimal system. It has now been confirmed that the causes of most primary idiopathic stenoses are often spot-like stenoses located at the site of anatomically preformed folds in the efferent tear ducts. Minimally invasive procedures of rechanneling have been developed, such as laser dacryoplasty and microdrill dacryoplasty, which preserve lacrimal pump function, result in much less stress for the patient and for a first-step procedure have an acceptable success rate of 80%.

Endoscopy of the lacrimal drainage system with miniaturized endoscopes has been possible since 1990 and permits the direct evaluation of the lacrimal drainage system. Additionally, attached instruments permit recanalization in cases of stenosis of the lacrimal drainage system. Both an Erbium-Yag Laser and a miniaturized drill are available, with which a stenosis of the lacrimal drainage system can be opened under endoscopic control. Favorable findings for endoscopic recanalization are stenoses in the area of the canaliculi or the lacrimal sac, for which the success rate of recanalization is approximately 75%. Unfavorable prognostic factors are submucous scar formations due to a dacryocystitis in the patient's history. Endoscopic findings have also improved the understanding of diseases of the lacrimal drainage system. Punctal stenoses causing epiphora often show intact mucous membranes before and behind the stenosis and it is possible to cure these patients without extensive surgical procedures. Micro-surgical procedures and dacryocystorhinostomy complete the spectrum of the endoscopic surgical possibilities in the lacrimal drainage system.

Transcanalicular microendoscopic diode laser DCR combined with 5-mm balloon dacryoplasty is an innovative procedure in lacrimal surgery. This procedure is minimally invasive and provides the possibility to fill the gap between the first step procedures (LDP, MDP) and external or internal DCR.

Lacrimal surgery has been characterised by multiple rapid changes within the last 20 years. The understanding of the development and existence of lacrimal stenoses has changed considerably. New morphological (endoscopy of the lacrimal system) and anatomic-functional aspects have been added. In the field of surgery the frequency of DCR has dropped within the last years, but still, with proper indications, this method has its significance, as well as irrigation of the lacrimal system. On the other hand microendoscopic canalicular surgery has been almost fully replaced by microendoscopic transcanalicular laser dacryoplasty and microdrill dacryoplasty. For the surgical treatment of injuries of the lacrimal system no changes have been implemented. As a spin-off effect from gastroduodenoscopy and ERCP superfine endoscopes have been developed, and have opened the possibility to inspect the mucosa and directly evaluate the lumen of the lacrimal system. Following the development of laser dacryoplasty and microdrill dacryoplasty as well as miniaturised drill systems, surgery can be performed less invasively today. Future developments of lacrimal surgery will be strongly influenced by the ongoing developments of microendoscopic transcanalicular techniques and modulation in wound healing.

Endoscopy of the lacrimal drainage system with miniaturized endoscopes has been possible since 1990 and permits the direct evaluation of the lacrimal drainage system. Additionally, attached instruments permit recanalization in cases of stenosis of the lacrimal drainage system. Both an Erbium-Yag Laser and a miniaturized drill are available, with which a stenosis of the lacrimal drainage system can be opened under endoscopic control. Favorable findings for endoscopic recanalization are stenoses in the area of the canaliculi or the lacrimal sac, for which the success rate of recanalization is approximately 75%. Unfavorable prognostic factors are submucous scar formations due to a dacryocystitis in the patient's history. Endoscopic findings have also improved the understanding of diseases of the lacrimal drainage system. Punctal stenoses causing epiphora often show intact mucous membranes before and behind the stenosis and it is possible to cure these patients without extensive surgical procedures. Micro-surgical procedures and dacryocystorhinostomy complete the spectrum of the endoscopic surgical possibilities in the lacrimal drainage system.