Factors affecting etiology and En-DCR outcomes in nasolacrimal duct obstruction: a retrospective cohort study

This study aimed to characterize the statistical profiles of potential pathogenic factors and identify determinants influencing the success of endoscopic dacryocystorhinostomy (En-DCR) through comprehensive analysis of clinical data from patients with nasolacrimal duct obstruction (NLDO).

We reviewed 1008 patients (1140 eyes) with nasolacrimal duct obstruction (NLDO) who underwent endoscopic dacryocystorhinostomy (En-DCR) between September 2020 and June 2023. Data on demographics, clinical features, previous diagnosis and treatment, preoperative interventions, and the results of NLDO-related examinations were recorded. Postoperative outcomes were assessed by reviewing clinic visit records and telephone follow-up conducted during routine care, with success defined as complete resolution of epiphora and patent irrigation. Multivariable logistic regression was used to identify independent risk factors associated with surgical outcome.

Among 1008 patients (1140 eyes), 35.9% had snoring/sleep apnea, 20.9% gastroesophageal reflux disease (GERD), and 19.3% a family history of epiphora. Of 851 females, 80.5% were menopausal, with 26.8% having gynecologic disease history and 11.5% prior gynecologic surgery. En-DCR achieved a 95.6% success rate. Multivariable analysis identified regurgitation on pressure over the lacrimal sac (ROPLAS) sign (OR = 0.25, 95% CI 0.13-0.48, p < 0.001) and minimum lacrimal sac diameter on dacryocystography (OR = 8.71, 95% CI 2.57-29.57, p < 0.001) as independent predictors of outcome.

NLDO frequently coexists with comorbidities including paranasal sinusitis/nasal polyps, chronic conjunctivitis, dry eye, GERD, family history of epistaxis, and sleep-disordered breathing (sleep apnea/snoring). Notably, ROPLAS sign and minimum lacrimal sac diameter ≤ 3 mm on dacryocystography independently predict En-DCR outcomes, with the latter demonstrating a particularly strong association (OR = 8.71, p < 0.001). These findings highlight the importance of preoperative assessment of lacrimal sac anatomy and clinical signs in optimizing surgical success.