Cause and Management of Patients With Failed Endonasal Dacryocystorhinostomy

Abstract

ObjectivesEndonasal dacryocystorhinostomy (DCR) is a well-established treatment method in patients with nasolacrimal duct obstruction. However, there are a few reports about the overall management of failed endonasal DCR. We investigated the causes and management strategies of failed endonasal DCR.MethodsThis retrospective review included 61 patients (61 eyes) who had undergone revision surgery by the same surgeon after failed endonasal DCR between January 2008 and December 2012. The appropriate revision method was determined after analysis of the etiology of failure by the fluorescein dye disappearance test, nasal endoscopy, lacrimal irrigation, and probing. The criteria for success of the revision surgery were defined by the passage of fluid without resistance upon lacrimal irrigation and normalization of the tear meniscus height.ResultsThe mean duration between the primary endonasal DCR and revision surgery was 15.3 months. The average follow-up period after revision surgery was 12.2 months. The most common cause of endoscopic revision surgery was membranous obstruction. Endoscopic revision surgery was performed in 48 patients, while lacrimal silicone tube intubation under endoscopy was performed in 13 patients. The most common indication for lacrimal silicone tube intubation was functional epiphora. The overall success rate of the revision surgery was 89%.ConclusionThe most common cause of failed endonasal DCR was membranous obstruction. When patients with failed endonasal DCR presented at the clinic, it is important to identify the cause of the failure. Revision surgery could increase the final success rate of endonasal DCR.

Endoscopic DCR using bipedicled interlacing mucosal flaps

“…As previously described in literature, the obstruction of the endonasal neo‐ostium by cicatricial stenosis with membranous obstruction, synechiae, and/or granuloma formation remains the most common reason for failed eDCR (51%–86%) . An additional significant cause of failure is inappropriate placement of the neo‐ostium or subtotal bone removal over the lacrimal sac .…”

“…1,2,4,5 As previously described in literature, the obstruction of the endonasal neo-ostium by cicatricial stenosis with membranous obstruction, synechiae, and/or granuloma formation remains the most common reason for failed eDCR (51%-86%). [6][7][8] An additional significant cause of failure is inappropriate placement of the neo-ostium or subtotal bone removal over the lacrimal sac. 3,9,10 Our surgical technique provides for safe and reproducible identification of the lacrimal sac, which ensures appropriate placement of the neo-ostium.…”

Comparative study of stenting and ostium packing in Endoscopic Dacryocystorhinostomy for Primary Acquired Nasolacrimal Duct Obstruction

“…Previous manometric study showed that lacrimal pump remained functional after DCR 22 . Other retrospective studies also showed that small or fibrotic lacrimal sacs 23 had a higher chance of functional failure. We postulated that postoperative ostia with better (deep and wide-open) shape were originated from larger, thinner, and more mobile lacrimal sacs while younger patients tend to have healthier, less fibrotic sacs with better "pump function".…”

Minimally Invasive Surgery of Lachrymal Outflow: Comparison of Techniques with Presentation of a Novel Surgical Dacryocystectomy Variant

“…This modified technique can expand the indications of DCT which can therefore be dedicated to cases of recurrent dacryocystitis (associated with dry-eye syndrome), frail subjects with high hemorrhage risk or affected by generalized vasculopathy or uncontrolled hypertension, subjects with conditions leading to ocular/nasal scarring or ascending infectious processes, subjects treated with antiglaucomatous drugs (in order to prevent systemic toxicity), patients presenting maxillofacial pyomucocele or malformations (even in case of previous surgery) and intraoperative assessments which lead to conversion from DCR to DCT (these should be obtained only under examination through operative microscopy) [22][23][24][25][26]. Since this modified DCT is also effective in treating "sticky eye" symptoms, it may be preferable to DCR especially for older patients complaining mainly mucopurulent discharges and episodes of dacryocystitis rather than "watery-eye".…”