Clinical Predictors of Surgical Management in Patients with Chronic Epiphora: A CT-DCG-Supported Analysis

Background: Chronic epiphora is a common ophthalmic complaint with multifactorial etiology, including both structural obstruction of the nasolacrimal drainage system (NLDS) and functional or ocular surface-related causes. Accurate differentiation between these conditions is essential for appropriate management, yet conventional diagnostic methods provide limited anatomical detail. The complementary role of advanced imaging in routine clinical decision-making remains incompletely defined. Methods: In this retrospective observational study, 127 patients with chronic epiphora who underwent CT-DCG as part of routine clinical care were analyzed. CT-DCG was performed in patients with suspected NLDS involvement. Clinical, functional, and imaging data were analyzed, and multivariable logistic regression was used to identify factors associated with surgical management. Results: Distal NLDS involvement was the most common CT-DCG finding. Purulent discharge and longer symptom duration were associated with surgical management. Duration of symptoms remained independently associated with surgical management (OR 1.04 per month, 95% CI 1.02-1.06, p < 0.001), while purulent discharge was also strongly associated, although the confidence interval was wide. Functional parameters, including fluorescein dye disappearance test and dry eye syndrome, were not independently associated. The model demonstrated good discrimination (AUC 0.89). Conclusions: CT-DCG provides detailed anatomical assessment of lacrimal drainage abnormalities in patients with chronic epiphora and may complement standard clinical evaluation in selected cases with suspected structural pathology. However, CT-DCG findings were analyzed primarily descriptively because several imaging subgroups were small. Clinical features such as prolonged symptom duration and purulent discharge were associated with surgical management, whereas functional tests alone showed limited independent association.