Bilateral simultaneous external dacryocystorhinostomy: outcomes and patient satisfaction in a single-stage approach

To evaluate the viability of simultaneous bilateral external dacryocystorhinostomy (ex-DCR) through a multidimensional analysis of surgical feasibility, patient-reported outcomes, complication incidence, and cost-efficacy.

The study included 54 eyes of 27 patients who underwent bilateral simultaneous ex-DCR for bilateral symptomatic epiphora due to NLDO. Patient symptoms were systematically assessed using the validated Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire. Additionally, all patients completed a Thurstone scale-based questionnaire to evaluate the surgical process and postoperative period in terms of functional success, psychological relief, overall satisfaction, economic benefits, and medical outcomes.

The mean patient age of 56.5 ± 13.1 years (range: 22-78) at the time of surgery. Postoperatively, the mean NLDO-SS decreased to 12.7 ± 5.7 (range: 2-26), demonstrating a statistically significant reduction in total scores (p < 0.001). The mean surgical duration was 72.0 ± 15.5 min (range: 52-125). No intraoperative or postoperative complications were observed in any patient. Anatomic success was achieved in 53/54 eyes (success rate: 98.1%), while functional success was observed in 52/54 eyes (success rate: 96.2%). Postoperative patient evaluation using the Thurstone scale revealed functional success scores of 4.5 ± 0.8 for the right side and 4.4 ± 0.8, psychological relief (4.6 ± 0.8), overall patient satisfaction (4.7 ± 0.6), economic advantages (4.7 ± 0.5), and medical benefits (4.7 ± 0.5).

Our preliminary findings demonstrate that single-session bilateral ex-DCR can be a safe and effective option in appropriately selected patients with high surgical success rates, reasonable operative duration, excellent patient satisfaction, and significant functional improvement without major complications.