External versus endonasal dacryocystorhinostomy: a single-centre United Kingdom study of 512 consecutive operations

To compare the surgical outcomes in patients undergoing elective external dacryocystorhinostomy (EX-DCR) and endonasal dacryocystorhinostomy (EN-DCR) for nasolacrimal duct obstruction (NLDO).

Retrospective non-randomized comparative clinical study. Electronic patient records were used to identify patients that underwent surgery for NLDO from 2013-2019 at Aintree University Hospital, Liverpool. Data regarding the type of operative procedure, patient demographics, preoperative, perioperative, and postoperative examination findings were recorded.

Five hundred and twelve patients underwent DCR surgery (316 EX-DCR and 196 EN-DCR). The EX-DCR cohort median age was 70 (142 males, 176 females), and the EN-DCR median age was 62 (46 males, 149 females). For primary NLDO, symptomatic improvement in treatment-naïve patients was 90.7% (234/258) and 92.2% (141/153), for EX-DCR and EN-DCR, respectively. Revision surgery for failed primary NLDO, was successful in 89.8% (53/59) and 77.3% (34/44), for EX-DCR and EN-DCR respectively. Mean post-operative follow-up was 7.48 months. Complications were rare overall and included epistaxis and granuloma, 1.6% and 2.0%, respectively.

Our overall surgical success rate at 90% (90.5% and 89.3% for EX-DCR and EN-DCR respectively) in primary NLDO are at the higher end of the spectrum of published data. Revision surgery is highly successful, and EX-DCR may be the preferred approach for revision surgery. Younger patients and females were more likely to undergo EN-DCR. Both surgical modalities are safe and complications rare.