Abstract
Purpose :
Sinonasal pathology such as chronic inflammatory disease or neoplasm can cause secondary nasolacrimal duct obstruction (NLDO). There is a paucity of data on presentation and dacryocystorhinostomy (DCR) outcomes for NLDO secondary to known sinonasal pathologies. This retrospective observational study describes case characteristics, management and surgical outcomes of complex NLDO at a tertiary academic center.
Methods :
Retrospective review of all DCR procedures with complete medical records and at least 3 months follow up, performed at a single institution over a 5-year period (2018-22). Patient and surgical characteristics were recorded, and compared between complex and simple NLDO groups with Chi-square or t-test for categorical and continuous variables, respectively. The primary outcome was functional success of DCR, assessed by improvement or resolution of epiphora at 3 months.
Results :
239 cases were included. Of those, 79 (33.1%) were identified as complex NLDO associated with sinonasal pathology. The reasons for complex NLDO were history of sinonasal cancer (48.1%), chronic inflammatory disease (34.1%), history of trauma (17.7%) or prior radiation to the relevant anatomical area (19%). DCR for complex cases was more likely to be performed endoscopically (68.4% vs. 31.3%, p<0.01), done by a multidisciplinary team of ENT and oculoplastic surgeon (70.9% vs. 8.1%, p<0.01) and require bilateral surgery (36.7% vs. 8.1%, p<0.01). Functional success was achieved in 78.9% of complex cases after initial DCR surgery and in 50% of revisions. The overall functional success rate was 70.9% for complex NLDO compared to 87.5% for simple cases (p=0.017). Lacrimal silicone stents remained in place longer in complex NLDO (124.67±74.51 vs. 81.9±52.82 days, p<0.01).
Conclusions :
Complex NLDO was more commonly managed with endoscopic DCR and a multidisciplinary surgical approach. Success rate of DCR in our complex cohort was lower compared to simple NLDO, and was similar to published DCR outcomes for secondary NLDO. These findings may facilitate surgical planning and patient counseling.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.