Endoscopic dacryocystorhinostomy with versus without silicone intubation in chronic dacryocystitis: a comparative meta-analysis

Dacryocystitis, an inflammation of the lacrimal sac typically caused by nasolacrimal duct obstruction (NLDO), is often treated with endoscopic dacryocystorhinostomy (EN-DCR). Silicone intubation is commonly employed during the procedure to help maintain ostial patency; however, its effectiveness remains debated. This systematic review and meta-analysis aims to determine whether silicone intubation improves surgical outcomes compared with EN-DCR performed without intubation in patients with chronic dacryocystitis (CD).

A comprehensive literature search of PubMed, Embase, Scopus, ScienceDirect, and CENTRAL identified 19 eligible retrospective and prospective studies involving 1,236 eyes (655 with intubation, 581 without) from inception to June 3, 2025. Studies were eligible if they involved patients with CD undergoing EN-DCR and compared outcomes between procedures performed with or without silicone intubation. Exclusion criteria included ipsilateral rhinitis, case reports, review articles, and studies without a comparative arm. Primary outcomes included surgical success rates, functional success, patency, and complication rates at various follow-up intervals. Risk of bias was assessed using Risk of bias 2 (ROB2) and Newcastle-Ottawa scale (NOS) for observational studies. Statistical analyses were conducted using RStudio (R version 4.6.1). Certainty of evidence was appraised using the GRADE framework, and publication bias was assessed via funnel plot asymmetry and Egger's regression test using RStudio (R version 4.6.1). This meta-analysis was registered in PROSPERO (ID: CRD420251072646).

The overall surgical-success analysis included 1,221 eyes and showed no statistically significant difference between EN-DCR with versus without silicone intubation (OR = 0.83, 95% CI [0.51-1.35], p = 0.46, I² = 26.5%). Results remained nonsignificant across follow-up subgroups (≤ 3 months: OR = 0.81, 95% CI [0.39-1.68], p = 0.57; approximately 6 months: OR = 1.58, 95% CI [0.78-3.17], p = 0.20; ≥ 12 months: OR = 0.49, 95% CI [0.21-1.16], p = 0.10), with no significant difference between subgroups (p = 0.11). No significant difference was observed in functional success (OR = 0.88, 95% CI [0.52-1.50], p = 0.64) or anatomical success assessed by irrigation (OR 0.99, 95% CI [0.63-1.56], p = 0.96) or endoscopic finding (OR 0.98, 95% CI [0.59-1.63], p = 0.94). Complication rates, including granulation tissue formation (OR = 1.71, p = 0.12), synechiae (OR = 0.95, p = 0.90), post-operative bleeding (OR = 0.65, p = 0.59), and punctal injury (OR = 1.55, p = 0.52), were comparable between groups. Stent expulsion occurred in 3% (95% CI [1-9%]) of intubated eyes. No significant publication bias was detected across all assessed outcomes (Egger's test, all p > 0.05). The overall certainty of evidence ranged from low for primary and anatomical outcomes to very low for complication outcomes per GRADE assessment.

In conclusion, the pooled analysis showed no statistically significant difference between EN-DCR with and without silicone intubation. However, the certainty of evidence ranged from low to very low, and the true comparative effect remains uncertain. Further long-term trials are warranted to clarify the indications for silicone intubation in EN-DCR.