Treatment Patterns, Outcomes, and Time-Investment in Symptomatic Epiphora due to Partial Nasolacrimal Duct Obstruction: Dacryocystorhinostomy vs. Nasolacrimal Duct Probing-Based Modalities

Abstract

Purpose : Management of epiphora from partial nasolacrimal duct obstruction (NLDO) includes many modalities whose efficacies vary. We performed a retrospective review to assess the treatment success and time-investment of balloon dacryoplasty (BD) and/or intubation vs. endoscopic (endo-) and external (ext-) dacryocystorhinostomy (DCR) as the primary treatment modality and factors associated with treatment success.

Methods : We performed a five-year, multi-institutional, retrospective review of patients with partial NLDO determined by lacrimal probing and irrigation. We excluded patients with canalicular or punctal stenosis and other causes of epiphora. Patients underwent primary nasolacrimal duct probing with or without stenting and/or BD (Group A) or endo- or ext-DCR (Group B). Treatment success, determined by physician assessment, postoperative irrigation, and patient self-reporting, and associated factors were explored. Data was analyzed in GraphPad Prism using non-parametric, Fisher’s exact, and Chi-square tests.

Results : Out of 838 patients with partial NLDO, 69 patients (87 eyes) met inclusion criteria. 72% of patients were female aged 54 ± 18.5 years at diagnosis. On diagnostic probing and irrigation, 24% of eyes had <50% stenosis, 51% of eyes had 50-75% stenosis, and 25% of eyes had >75% stenosis. The mean time to first intervention was 6.4 ± 10.9 months from initial presentation. Patients in Group A vs. Group B experienced complete (49% vs. 63%), partial (41% vs. 33%), and no improvement (10% vs. 4%) in epiphora resolution, with no difference between groups (p>0.05). 22% of eyes in Group A and 4% in Group B required a second surgery on average 11.2 ± 6.8 months after first surgery. Prior septal trauma (p<0.01) and degree of postoperative epiphora resolution (p=0.02) were associated with receiving a second surgery. Among patients in Group A vs. Group B, the average number of office visits (7.2 ± 5.3 vs. 5.5 ± 2.7) and number of months to definitive surgery (8.0 ± 9.0 vs. 8.0 ± 13.8) were not significantly different (p=0.12, p=0.44).

Conclusions : There was no significant difference in symptomatic outcomes and time-investment in patients with partial NLDO undergoing DCR versus less invasive procedures. These findings support a treatment model based on shared decision-making between the surgeon and patient.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.