Modified conjunctivodacryocystorhinostomy for upper lacrimal system obstruction

To describe a modified technique for conjunctivodacryocystorhinostomy (CDCR) and to compare this technique with the standard transcaruncular placement of the glass tube.

Patients with upper lacrimal system obstruction underwent CDCR at the Jules Stein Eye Institute during a 3-year period. Thirteen patients underwent modified CDCR leaving the caruncle intact, while 7 patients underwent Jones glass tubes placement through a caruncular incision (conventional CDCR). Data regarding ocular and tearing history were recorded and analyzed. Success rates, defined as complete improvement in tearing, were compared between patients who underwent standard CDCR and those who underwent modified CDCR. Main outcome measures included symptom relief, patients' tolerance of the Jones tube, and surgical complications.

Nineteen patients (12 men and 7 women; mean age, 66 years) underwent 20 CDCR surgical procedures with Jones tube placement. Previous lacrimal history included malignancy of the ocular adnexa, trauma, chemotherapy, and previous failed dacryocystorhinostomy. Success was found in 13 surgical cases (65%) and partial improvement was found in 4, giving a qualified success rate of 85%. Patients who underwent modified CDCR were more likely to undergo a successful surgery compared with patients who underwent conventional CDCR, with 11 (85%) of 13 cases achieving complete improvement vs 2 (29%) of 7 cases in the conventional CDCR group (P = .03, Fisher exact test). Complications included 1 case of migration and loss of the Jones tube.

Modified CDCR results in partial or complete resolution of tearing in nearly 92% of cases, allowing for an improved outcome both functionally and cosmetically compared with conventional CDCR.