External Dacryocystorhinostomy for the Treatment of Functional Nasolacrimal Drainage Obstruction

Abstract

Objectives:To determine the outcome and long-term efficacy of external dacryocystorhinostomy (ext-DCR) with or without bicanalicular silicon intubation in patients with functional nasolacrimal drainage obstruction (FNLDO).Materials and Methods:Patients with epiphora and patent lacrimal systems on nasolacrimal irrigation were prospectively enrolled in the study. Each patient was assessed with lacrimal scintigraphy to differentiate drainage abnormalities as presac (proximal) or postsac (distal) delays. All patients underwent ext-DCR; bicanalicular silicone intubation was performed only in presac delay cases. On follow-up examinations patients were asked to report their symptoms as none, mild, moderate or unchanged. Success was defined as lacrimal patency to irrigation and no or mild epiphora at the end of the follow-up period.Results:Twenty-six lacrimal systems of 23 patients were eligible for inclusion. There were 9 presac delay and 17 postsac delay cases. Average follow-up time was 72.85 weeks (47-88 weeks). A successful outcome was achieved in 76.9% of the operated lacrimal systems. Success rate was 55.5% among presac obstructions and 88.2% among postsac obstructions.Conclusion:The long-term efficacy of ext-DCR in FNLDO patients is confirmed with our overall successful outcome of 76.9%. In preoperative assessment, lacrimal scintigraphy is helpful to determine the surgical approach and to predict the surgical outcome.

Diagnostic value of lacrimal scintigraphy in the evaluation of lacrimal drainage system obstruction: a systematic review and meta-analysis

“…These findings may support the multifactorial cause for epiphora, which should not be assessed only from the anatomical point of view. Noteworthy, some of these nonobstructive eyes improve after surgical intervention [23,36,[45][46][47][48][49][50]. Hence, it is of great importance to differentiate those with a favorable surgical outcome.…”

“…This classification may be of relevance in decision making as well as assessment of outcome after the procedures. The successful surgery has been reported in 83.3–91% of LDS in the postsac and 47–66% in the presac patterns [47–49]; this correlation has not been observed in all studies [23].…”

“…The successful surgery has been reported in 83.3-91% of LDS in the postsac and 47-66% in the presac patterns [47][48][49]; this correlation has not been observed in all studies [23].…”

Outcome of External Dacryocystorhinostomy and Monocanalicular Intubation in Patients with Total Obstruction of One Canalicus

“…Simsek et al [11] demonstrated the long-term efficacy of external DCR in functional NLDO patients with presac delay. External DCR may be also effective in the management of epiphora in patients with one intact canaliculus without NLDO by facilitating lacrimal drainage.…”