Partial orbital lobe dacryoadenectomy for refractory epiphora

To evaluate the efficacy of partial orbital lobe dacryoadenectomy (POLD) in patients with refractory epiphora.

Prospective interventional study.

Tertiary eye care institute.

Consecutive patients with refractory epiphora due to proximal lacrimal outflow system obstruction, multiple failed dacryocystorhinostomy, and postdacryocystectomy. All patients underwent preoperative assessment with Munk score, Schirmer-I Score, tear breakup time, corneal fluorescein staining, anterior segment OCT (AS-OCT), and CT scans of the orbit.

Partial removal of the lacrimal gland orbital lobe under local anesthesia.

Reduction in epiphora. Objective and subjective evaluation was repeated at postoperative 1-week, 1-month, and 3-month visits.

Out of 17 patients enrolled, one had congenital punctal agenesis, three had acquired punctal effacement, and 13 had proximal bicanalicular obstruction. The mean age was 48.8 ± 18.6 years. All patients underwent POLD, with removal of 50-60% of the orbital lobe of the lacrimal gland. The mean follow-up duration was 5.7 months. At 3-month follow-up visit, the average reduction in Munk score was 60%, the average reduction in Schirmer-I value was 35.2%, and the average reduction in tear film height on AS-OCT was 35.9% (all statistically significant, P < 0.05), from the initial visit. None of the patients developed signs and symptoms of dry eye disease.

POLD is an effective and safe procedure for patients with refractory epiphora in the short term. Further studies are needed to establish efficacy in the long term.