Lacrimal duct Surgery: Different Techniques and Long-Term Postoperative Results

Abstract

Pre-saccal obstructions of the lacrimal duct can be solved with a conjunctivodacryocystorhinostomy while saccal or post-saccal obstructions are restored with an external, endoscopic or laser dacryocystorhinostomy (DCR). The aim of the present study is to review the indications for each technique and to compare the results achieved. Retrospective review of 335 patients in whom 440 surgeries of the lacrimal duct were performed, with at least 4 months of follow-up. Outcomes in terms of symptoms and endoscopic findings during follow-up were considered. Successful results understood as resolution of symptoms were observed in 85% of cases treated with endoscopic DCR and in 62% of cases after laser DCR (p < 0.001). Among patients with recurrence of epiphora after surgery, 32% showed a visible ostium during endoscopy. Sixty-eight conjunctivodacryocystorhinostomies were performed, 68% of which required a tube replacement due to obstruction or extrusion. The mean duration of the tubes replaced was 10 months (range 3 days - 95 months). Endoscopic DCR shows better success rates than laser DCR. A considerable percentage of failures after DCR surgery present a visible ostium on endoscopic examination. This fact should lead to reconsider the initial diagnosis, ruling out functional problems or canalicular obstructions.

Keywords: Conjunctivodacryorhinostomy; Dacryocystorhinostomy; Endoscopic surgery; Epiphora; Lacrimal duct obstruction.

Fig. 1

Kaplan-Mayer graph showing actuarial recurrence-free survival in months for E-DCR and L-DCR groups. Time is calculated after the removal of the silicone stent