A comparison of external and endoscopic endonasal dacryocystorhinostomy for acquired nasolacrimal duct obstruction

Purpose To compare success rates of external dacryocystorhinostomy (DCR) and endoscopic endonasal DCR for acquired nasolacrimal duct obstruction (NLDO). Design Historical cohort study. Participants 100 patients who underwent external DCR and 105 patients who underwent endoscopic endonasal DCR. Methods A retrospective review of medical records of patients with acquired NLDO who underwent DCR from 2004–2010 was performed. Data regarding the lacrimal drainage system, eye examination, surgical outcomes, patient symptom control, and postoperative care were analyzed. Main outcome measures Surgical success was defined by patient’s resolution of symptoms with patency on irrigation. Surgical failure was defined as no symptomatic reduction in epiphora and/or an inability to irrigate the lacrimal system postoperatively. Results A total of 205 patients underwent surgeries for acquired NLDO. The average age was 69 years, and 62.4% of subjects were female. Pooled results showed that both surgical approaches had similar success rates (endoscopic endonasal DCR 82.4% versus external DCR 81.6%; P = 0.895). Complication rates were low in both types of surgery. This included three patients with postoperative hemorrhage (two who had endonasal DCR surgery and one having external DCR surgery). This resolved with conservative treatment. Postoperative problems with lacrimal patency (including canalicular obstruction) occurred to 6.8% of endoscopic patients and 9% of those with the external DCR surgery. Of the 14 patients who had their silicone tubes fall out before the 2-month assessment, 10 were classified as failures (71%), in contrast to only a failure rate of 13.9% of those whose tubes were present for the recommended time. This difference was statistically significant (P < 0.01). Conclusion The success rate of DCR for acquired NLDO in our group of patients was high overall with a low complication rate between the two types of surgery. There was no statistically significant difference between endoscopic and external DCR. Endoscopic surgery may have a benefit of preserving the lacrimal pump system and leaving no surgical scar. Patient preference and availability of each service should direct management. Hence endoscopic endonasal DCR surgery should be considered for primary treatment of nasolacrimal duct obstruction.

[1]  P. McCluskey,et al.  External Dacryocystorhinostomy: Assessing Factors that Influence Outcome , 2010, Orbit.

[2]  S. Leong,et al.  A Systematic Review of Outcomes after Dacryocystorhinostomy in Adults , 2010, American journal of rhinology & allergy.

[3]  S. Leong,et al.  A comparison of outcomes between nonlaser endoscopic endonasal and external dacryocystorhinostomy: single-center experience and a review of British trends. , 2010, American journal of otolaryngology.

[4]  S. Agarwal Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction. , 2009, The Journal of laryngology and otology.

[5]  S. Br Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy. , 2009 .

[6]  N. Sonkhya,et al.  Endoscopic transnasal dacryocystorhinostomy with nasal mucosal and posterior lacrimal sac flap , 2008, The Journal of Laryngology & Otology.

[7]  B. Ram,et al.  Comparison of external and endonasal dacryocystorhinostomy , 2008, The Journal of Laryngology & Otology.

[8]  B. R. Sharma Non endoscopic endonasal dacryocystorhinostomy versus external dacryocystorhinostomy. , 2008, Kathmandu University medical journal.

[9]  R. Youngs,et al.  Endoscopic endonasal laser versus endonasal surgical dacryocystorhinostomy for epiphora due to nasolacrimal duct obstruction: prospective, randomised, controlled trial. , 2007, The Journal of laryngology and otology.

[10]  P. McCluskey,et al.  Assisted local anaesthesia for endoscopic dacryocystorhinostomy , 2007, Clinical & experimental ophthalmology.

[11]  P. Wormald,et al.  Mechanical endonasal dacryocystorhinostomy with mucosal flaps. , 2006, Otolaryngologic clinics of North America.

[12]  B. Sloan Essentials in Ophthalmology: Oculoplastics and Orbit , 2006 .

[13]  M. Draper,et al.  Endoscopic dacryocystorhinostomy in warfarinized patients. , 2006, American journal of otolaryngology.

[14]  M. Choi,et al.  Endoscopic Dacryocystorhinostomy: Creation of a Large Marsupialized Lacrimal Sac , 2006, Journal of Korean medical science.

[15]  G. Rose The Apparent Paradox of “Success” in Lacrimal Drainage Surgery , 2006 .

[16]  R. Schwarcz,et al.  External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. , 2005, Ophthalmology.

[17]  D. Gatland,et al.  Endoscopic dacrocystorhinostomy: long-term results and evolution of surgical technique , 2004, The Journal of Laryngology & Otology.

[18]  G. Rose The lacrimal paradox: toward a greater understanding of success in lacrimal surgery. , 2004, Ophthalmic plastic and reconstructive surgery.

[19]  M. Yung,et al.  Concomitant nasal procedures in endoscopic dacryocystorhinostomy , 2004, The Journal of Laryngology & Otology.

[20]  G. Zilelioǵlu,et al.  Results of endoscopic endonasal non-laser dacryocystorhinostomy , 2002, Documenta Ophthalmologica.

[21]  Anna Szymańska-Skrzypek,et al.  [Endonasal dacryocystorhinostomy]. , 2004, Otolaryngologia polska = The Polish otolaryngology.

[22]  P. Dolman Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. , 2003, Ophthalmology.

[23]  P. Wormald,et al.  Endonasal dacryocystorhinostomy with mucosal flaps. , 2003, American journal of ophthalmology.

[24]  P. Wormald,et al.  Powered endoscopic dacryocystorhinostomy. , 2002, The Laryngoscope.

[25]  J. Olver,et al.  Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: surgical and holmium laser. , 2002, Ophthalmology.

[26]  A. Aslan,et al.  Comparison of Surgical Outcomes in Primary Endoscopic Dacryocystorhinostomy with and without Silicone Intubation , 2002, The Annals of otology, rhinology, and laryngology.

[27]  M. Yung,et al.  Analysis of the results of surgical endoscopic dacryocystorhinostomy: effect of the level of obstruction , 2002, The British journal of ophthalmology.

[28]  M. Onerci Dacryocystorhinostomy. Diagnosis and treatment of nasolacrimal canal obstructions. , 2002, Rhinology.

[29]  R. Khooshabeh,et al.  External dacryocystorhinostomy for the treatment of acquired partial nasolacrimal obstruction in adults , 2002, The British journal of ophthalmology.

[30]  M. Assouline,et al.  Systematic unciformectomy for a standardized endonasal dacryocystorhinostomy. , 2002, Ophthalmology.

[31]  H. Er,et al.  Comparative External Versus Endoscopic Dacryocystorhinostomy: Results in 115 Patients (130 Eyes) , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[32]  M. Orhan,et al.  Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy. , 2000, Acta oto-laryngologica.

[33]  R. Grenman,et al.  Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy , 1998, The Laryngoscope.

[34]  G. Thurairajan,et al.  External dacryocystorhinostomy—an end of an era? , 1997, The British journal of ophthalmology.

[35]  W. Zhou,et al.  Endoscopic Intranasal dacryocystorhinostomy in forty-five patients. , 1996, Chinese medical journal.

[36]  H. Whittet,et al.  Endoscopic transnasal dacryocystorhinostomy -long-term results , 1996 .

[37]  P. Custer,et al.  External Dacryocystorhinostomy: Surgical Success, Patient Satisfaction, and Economic Cost , 1995 .

[38]  R. K. Dortzbach,et al.  Results of endonasal laser-assisted dacryocystorhinostomy. , 1994, Ophthalmology.

[39]  R. Metson,et al.  Endoscopic Surgery for Lacrimal Obstruction , 1991, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.