Outcome of endoscopic dacryocystorhinostomy in elderly versus younger adults: a comparative analysis

To evaluate whether age ≥80 years independently influences outcomes after endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction (NLDO).

A retrospective cohort study.

Three hundred forty-six consecutive adults underwent standardized endonasal DCR between 2011 and 2023; 31 were ≥80 years.

Preoperative comorbidities, intraoperative variables and postoperative course were prospectively recorded. Outcomes-ostium patency, symptom relief, complications and revision-were assessed at a median of 12 months (IQR 6-24). Kaplan-Meier curves and multivariable Cox proportional-hazards models identified independent predictors.

Octogenarians had more hypertension (64.5% vs 26.0%; p < 0.001) and hypothyroidism (25.8% vs 7.3%; p = 0.003). Silicone intubation was less common in this group (32.3% vs 54.0%, p = 0.021) but did not affect outcomes. Anatomical success was 83.9% in octogenarians versus 84.1% in younger adults (p = 0.97); functional success was 74.2 % versus 76.2% (p = 0.81). Complication (12.9 % vs 16.2 %; p = 0.64) and revision (3.2 % vs 4.1 %; p = 0.78) rates, as well as 24-month event-free survival, did not differ. Age ≥80 years was not an independent predictor of failure (Hazard Ratio: 0.93, 95% CI: 0.44-1.98).

Despite greater systemic morbidity, very elderly patients achieved safety and efficacy equivalent to younger adults. Chronological age alone should not preclude endoscopic DCR; these real-world data support offering minimally invasive lacrimal surgery and -evidence-based counseling to an aging population.