Endoscopic dacrocystorhinostomy: Reasons for failure and possible solutions

Area of Science:

• Ophthalmology
• Otorhinolaryngology
• Surgical Innovation

Background:

• Endoscopic dacryocystorhinostomy (EDCR) is a common surgical procedure for nasolacrimal duct obstruction.
• Despite high success rates, various factors can lead to surgical failure.
• Understanding these failure causes is essential for improving patient outcomes.

Purpose of the Study:

• To investigate the primary reasons for failure in endoscopic dacryocystorhinostomy.
• To identify strategies for addressing and overcoming these causes of failure.
• To enhance the success rates of revision EDCR procedures.

Main Methods:

• Retrospective review of 117 patients who underwent revision endoscopic dacryocystorhinostomy over an 11-year period (2008-2018).
• Inclusion criteria: patients diagnosed with failed EDCR presenting to an Otorhinolaryngology outpatient department.
• Preoperative assessment included history, examination, and diagnostic nasal endoscopy.

Main Results:

• The most frequent cause of failure was incomplete lacrimal sac exposure (100%).
• Other significant causes included cicatricial closure of the ostium (40.1%), synechiae (17%), and canalicular obstruction (3.4%).
• Symptoms like epiphora and discharge were prevalent in the studied patient cohort.

Conclusions:

• Thorough and meticulous lacrimal sac exposure is paramount for successful EDCR.
• Comprehensive preoperative evaluation, precise surgical technique, and diligent postoperative care are critical for optimal results.
• Addressing specific failure factors can significantly improve revision EDCR success rates.