Improving outcomes by combining septoplasty with primary external dacryocystorhinostomy

Area of Science:

• Ophthalmology
• Otorhinolaryngology

Background:

• Acquired nasolacrimal duct obstruction is commonly treated with external dacryocystorhinostomy (EXT-DCR).
• Intranasal pathologies, such as nasal septal deviations, can compromise the success of EXT-DCR procedures.
• Nasal septal deviations are a known cause of DCR failures, necessitating revision surgery.

Purpose of the Study:

• To investigate the causes of EXT-DCR failure in a patient population.
• To determine if concomitant treatment of septal deviations during primary EXT-DCR can decrease revision surgery rates.

Main Methods:

• Retrospective review of patients who underwent EXT-DCR.
• Analysis of failure causes, specifically nasal septal deviations.
• Evaluation of outcomes for combined EXT-DCR and septoplasty procedures.

Main Results:

• Over a five-year period, 12 EXT-DCR failures were identified, with 8 directly linked to nasal septal deviations.
• Revision surgery after septal deviation correction was successful in all 8 cases.
• A combined EXT-DCR and septoplasty approach in 8 consecutive patients resulted in a 90% success rate, with the single failure due to canalicular obstruction.

Conclusions:

• Treating nasal septal deviations concurrently with primary EXT-DCR can minimize the requirement for subsequent revision surgeries.
• Addressing unfavorable nasal anatomy during the initial procedure enhances the overall success of tear duct obstruction treatment.