Q-Needle-Assisted Intraductal Injection Enhances Dacryoendoscopic Surgery for Primary Acquired Lacrimal Drainage...

Background/Objectives: Primary acquired lacrimal drainage obstruction (PALDO) is a common cause of epiphora. Although dacryoendoscopic recanalization (DER) is widely performed, its long-term success is limited by restenosis related to fibro-inflammatory processes. This study aimed to evaluate the efficacy of a novel Q-needle for targeted intraductal delivery of antifibrotic and anti-inflammatory agents during DER. Methods: A retrospective review was performed on 190 eyes treated with DER, silicone tube intubation (SI), and retrograde intraductal injection via the inferior meatus using a Q-needle. A mixture of dexamethasone (1 mL), 5-fluorouracil (1 mL), and triamcinolone acetonide (1 mL) was administered directly into the obstruction site under endoscopic visualization. Obstruction type was classified intraoperatively as secretory or structural based on dacryoendoscopic findings. Results: The overall surgical success rate was 92.1%, with significantly greater success in secretory-type PALDO compared to the structural type (96.8% vs. 87.4%, p = 0.031). These outcomes contrast with previous reports in which secretory-type PALDO was associated with poorer prognosis after DER. Conclusions: The improved outcomes in the secretory group suggest a potential role of combined antiproliferative and multi-phase anti-inflammatory therapy in effectively addressing the key mechanisms of restenosis. Q-needle-assisted intraductal injection during DER may represent a simple and safe adjunctive approach to improve surgical consistency and long-term patency in patients with PALDO.