Background: To evaluate possible causative factors of unsuccessful dacryocystorhinostomy (DCR) surgery, and present the surgical technique and results of revision external DCR in a tertiary referral center. Methods: During 2001–2007, 79 patients (59 female, 20 male, 83 revised DCR sites) underwent revision external DCR for the management of recurrent epiphora after unsuccessful DCR surgery. The possible reasons for unsuccessful DCR surgery were noted according to the preoperative nasal endoscopic and perioperative findings, and revision surgery was performed to address these. Results: The mean age was 43.1 ± 12.0 years, and the mean follow-up was 21.4 ± 12.4 months. At presentation, 58 patients had a history of 1 unsuccessful lacrimal surgery, 16 had 2 unsuccessful surgeries, and 5 had 3 unsuccessful surgeries. The most common preoperative endoscopic finding was nasal mucosal fibrosis and synechiae, and the most common causes of unsuccessful DCR surgery were inappropriate size and location of the bony ostium, fibrosis at rhinostomy site, and canalicular obstruction, respectively. Of the 83 revised DCR sites, 79 sites underwent external DCR with silicone intubation, and conjunctival DCR with Jones tube insertion was performed in 4 sites. Success was achieved in 78 sites (93.9%) with the first revision DCR surgery, and in 81 sites (97.6%) with the second revision. Conclusions: Revision DCR has standard concepts in common with primary DCR surgery; however, for a favorable surgical outcome, the revision surgery should address possible causative factors of failure.

with Cyclosporine A ophthalmic solution (0.05%) in treating the signs and symptoms of VKC. Material and Method: Twenty-five patients with VKC were included in a prospective study. One eye of each patient was treated with Olopatadine while the other eye was treated with Cyclosporine A. Subjective symptoms of the patients such as itching, tearing, foreign body sensation, and mucus discharge were recorded and scored. The objective signs, such as the presence of giant papillae on the tarsal conjunctiva, bulbar conjunctival hyperemia, keratitis, limbal hypertrophy, corneal vascularization, and conjunctival cicatrization, were scored. Results: There was no significant difference between the Olopatadine group and the Cyclosporine A group regarding subjective symptoms at the 3rd, 6th, 12th, and 18th month. There was a significant improvement in the subjective symptoms of both groups. No significant difference was seen between the groups with regard to objective signs. A significant improvement was observed in the Cyclosporine group in the late period of the study. Discussion: In long-term therapy of VKC, similar effects were seen regarding improvement in the subjective symptoms during the use of topical Olopatadine and Cyclosporine A. In terms of improvement regarding the objective signs, Cyclosporine A was seen to be more effective in the late period.

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