Utility of FICI grading in lacrimal practice: a study of 456 dacryocystorhinostomy ostia

To evaluate the dacryocystorhinostomy (DCR) ostia via nasal endoscopy using the FICI-grading system following external and endoscopic DCRs.

Our prospective study evaluated all DCR ostia following single surgeon (MS) surgeries. The FICI grading system includes the Fluorescein endoscopy dye test (FEDT), internal common opening (ICO) dynamicity, cicatricial ostium closure, and ICO threats. A score of 5 means excellent (no intervention required), 3-4 is good (rarely needs intervention), and 0-2 is poor (needs definitive intervention). The DCR ostium score (FICI grading) was obtained at each postoperative visit, i.e. 4 weeks (simultaneous stent removal), 3 months, 6 months, and 12 months follow-up. The patients who had previously undergone dacryocystectomy or did not complete the follow-up protocol visits and follow-up of <12 months were excluded from the study.

A total of 310 (67.98%) eyes had external DCR and 146 (32.02%) eyes underwent an endoscopic DCR procedure. The mean age of patients at surgery was 48.5 years. Out of these 456 ostia (400 patients), 309 (67.76%) patients fall within excellent grades, 74 (16.23%) in good, and 29 (6.36%) in poor grades. Failure of the DCR surgery was predicted and experienced in 16 eyes (3.51%) for which revision surgery was suggested.

The FICI grading system of DCR ostium is a user-friendly, quick, and effective method of monitoring the ostium in the postoperative period, for both external and endoscopic DCRs. It also provides a structured and simple method to predict the success after DCR surgery.