Combined Endoscopic and Minimally Open Technique for Total Resection of the Lacrimal Apparatus for Malignant and Benign Tumors of the Lacrimal System

Introduction: Endoscopic and external approaches for treatment of lacrimal apparatus disease are well established techniques. Previous studies have examined the role of these techniques for the extirpation of portions of the lacrimal system for both benign and malignant pathologies. However, the utility of a combined endoscopic and minimally open approach for an en bloc resection of the lacrimal apparatus has not been well studied. This study aims to describe a single tertiary care center’s experience with using this technique for management of lacrimal system tumors. Methods: Retrospective chart review of patients presenting with tumors involving the lacrimal system whose surgical plan included a combined open and endoscopic resection of the lacrimal apparatus. The endoscopic approach included resection of the lateral nasal wall from the lacrimal sac to the nasal floor. This connected to the open medial canthal approach resulting in the en bloc resection of the lacrimal apparatus. Results: A total of 7 patients from July 2015 until August 2025 were included in this study. Of the 7 patients, 3 were male and 4 were female with a mean age at presentation of 69.1 years (range: 59.9 – 74.5 years). The mean follow up was 43.1 months (range: 1.4 - 121.8 months). The histopathologic diagnoses included: 2 squamous cell carcinomas, 1 sebaceous carcinoma, 1 melanoma, 1 basaloid carcinoma, 1 mucoepidermoid carcinoma, and 1 inverted papilloma. The puncta and canaliculi were additionally contained in the en bloc removal for 4 patients, of which one also had inclusion of the anterior orbit from concurrent exenteration. The patient with melanoma had an endoscopic only resection performed as intra-operative biopsy of the common canaliculus was negative for malignancy. Adjuvant radiation therapy was performed in 3 of the 6 cases, with the melanoma patient receiving adjuvant immunotherapy. The patient with basaloid carcinoma had a locoregional recurrence which required revision surgery and adjuvant radiation therapy. All patients were disease-free as of their last follow up. Conclusion: The combined endoscopic and open approach for en-bloc resection of the lacrimal drainage system is an effective technique for the management of tumors arising from and involving the lacrimal apparatus. It can provide targeted en bloc removal of the lacrimal apparatus based on the extent of the tumor. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany