Although endoscopic dacryocystorhinostomy (EDCR) has been performed successfully in primary and revision cases, there has yet to be a consensus on the best surgical approach.

Excessive granulation, adhesion, and fibrosis, the main causes of unsuccessful EDCR, should be expected more frequently in revision surgery. Anastomosis by ligating the nasal mucoperiosteum and lacrimal sac flaps with clips can minimise the surface of exposed bone, therefore, the possibility of stenosis and failure of the dacryocystorhinostomy.

In 12 revision EDSR patients, ligating clips ensured an anatomical overlap of the mucoperiosteum and sac flap, providing a wider rhinostomy opening and straight epithelial lining.