Dacryocystorhinostomy Practice Patterns Among ASOPRS Members: A Shift in Preferences and Attitudes

To determine current dacryocystorhinostomy (DCR) practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery members and identify surgeon and case-related factors impacting preference for endoscopic versus external DCR and the use of preoperative imaging.

A cross-sectional web-based anonymous 16-question survey was distributed to 277 American Society of Ophthalmic Plastic and Reconstructive Surgery members enrolled in survey-based research. The survey assessed surgeons' demographics, practice settings, surgical preferences, and imaging practices. Responses were summarized and compared using statistical tests for frequency distribution.

A total of 111 surgeons (40.0%) responded to the survey. Utilization of endoscopic DCR (endoDCR) was highly variable, with 57% of junior surgeons (<5 years in practice) using it for >66% of their cases, compared with only 18.3% of surgeons with >15 years postfellowship experience. High utilization of endoDCR (>66% of cases) was more common in academic surgeons compared with private practice (48.4% vs. 19.6%, p < 0.01). The most cited reasons for endoDCR were scar avoidance and revision surgery. For external DCR, anatomical barriers and concern for mass/need for biopsy were common indications. Most surgeons only order imaging for certain indications, such as prior sinonasal surgery, facial trauma, suspected tumor, or atypical presentation.

Utilization of endoDCR was correlated with years in practice, with younger surgeons preferring the endoscopic technique. A large majority felt that the relevance of imaging is low in most patients. Future research is needed to standardize case-based indications for endoscopic versus external approaches and preoperative imaging.