Objective: To evaluate the nasolacrimal ostium created after successful external dacryocystorhinostomy. Methods: This prospective study included 41 successful primary external dacryocystorhinostomies performed in 41 patients with nasolacrimal duct obstruction (33 women and 8 men; age range, 19-75 years). The dimensions of osteotomy were measured during surgery. Patients alternately underwent either anterior only or anterior and posterior flap anastomosis between the lacrimal sac and the nasal mucosa. Digital subtraction macrodacryocystography was performed to assess the nasolacrimal ostium 6 months after surgery. Results: Dacryocystography showed that the lacrimal sac had reformed in 40 (98%) of 41 patients. The nasolacrimal ostium was located at the inferior part of the reformed sac in 37 patients (90%) and at the middle part

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The success rate of the nasolacrimal stent decreases as follow-up lengthens. After stent treatment, lacrimal symptoms frequently develop, even if the stent remains patent, and require multiple office visits and therapy. The polyurethane stent may induce a chronic inflammatory response in the lacrimal sac, which can interfere with subsequent dacryocystorhinostomy.

Prenatal MRI can delineate congenital dacryocystocele more clearly and in a more detailed fashion than ultrasonography. Presence of dacryocystocele was symptomatic in only 50% of our patients, supporting that prenatal diagnosis of dacryocystocele might follow a benign course.