Outcomes of risk stratification and dacryocystorhinostomy in patients with acquired nasolacrimal duct obstruction

Abstract

Purpose : Multiple factors can increase the risk of sinonasal pathology and compromise success of external dacryocystorhinostomy (DCR). At this center, patients with these risk factors are referred to otolaryngology (ENT) preoperatively. Those found to have sinonasal pathology undergo a multidisciplinary approach which includes concomitant treatment of sinonasal pathology with an external DCR. We aimed to evaluate the outcomes of this combined approach and compare it to the solely external approach for patients with these risk factors who are evaluated by ENT.

Methods : A retrospective review of all patients undergoing primary DCR at a tertiary care center from June 1, 2020 to January 1, 2022 was conducted. The primary outcome was the success of the approach. Failure was defined as persistent symptoms of tearing and/or a lack of patency upon irrigation of the nasolacrimal duct system. Statistical analysis was performed with SPSS using independent t tests and Chi-square analysis.

Results : A total of 59 patients underwent DCR (Figure 1). Eight (13.5%) patients had no risk factors and underwent only an external DCR with no failures. Of the 51 (86.4%) patients with risk factors, 22 were not evaluated by ENT and underwent the solely external approach, with 3 failures (13.6%). The remaining 29 were evaluated by ENT. Fifteen patients were not found to have any sinonasal pathology contributing to obstruction of lacrimal drainage and proceeded with external DCR with 4 failures (26.7%). The other 14 patients underwent a combined approach with external DCR and endoscopic sinonasal surgery with 4 failures (28.6%). For the patients with risk factors who were evaluated by ENT, those who underwent the combined approach were compared to those who underwent only external DCR (Table 1). No significant difference was found between the groups.

Conclusions : Our study reveals that preoperative risk stratification and evaluation by ENT is important in determining whether endoscopic intervention is warranted. In patients with risk factors, concomitant treatment of sinonasal pathology with external DCR allows for comparable success rates to those found not to have any sinonasal pathology who are treated with external DCR only.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure 1. Flow chart of patients included

 

Table 1. Characteristics and surgical outcomes for patients with risk factors for sinonasal pathology