Conjunctivodacryocystorhinostomy (CDCR) success rates and complications in endoscopic vs non‐endoscopic approaches: a systematic review

Abstract

Background Epiphora due to refractory bicanalicular obstructions is typically managed by conjunctivodacryocystorhinostomy CDCR with or without the assistance of nasal endoscopy However the evidence for its benefit is unclear Methods A systematic review of the literature on the treatment of epiphora by CDCR was performed March All studies reporting original data on patients suffering from epiphora treated with CDCR surgery were included Primary outcomes were success and satisfaction rates Secondary outcomes were CDCR complications A comparison was made between the results obtained in patients undergoing CDCR with vs without assistance of nasal endoscopy Results Fi y-four studies representing information on CDCR procedures were included in the systematic review All the studies are case series most of them retrospective Lester Jones tube LJT is the most commonly used in CDCR The overall success rate with all studies included n = was n = in CDCR with assistance of nasal endoscope and n = in the non-endoscopic approach The overall "tube displacement" rate the most common complication was n = n = tube displacement in CDCR with assistance of nasal endoscope vs n = in the non-endoscopic approach Only studies used patient-reported outcome measures PROMs to evaluate epiphora improvement Due to the low level of evidence and the high bias of the studies a meta-analysis was not performed Conclusion Based on the data available in the literature CDCR is considered an effective procedure for treating epiphora due to proximal obstruction Controlled and qualitative studies are needed to clarify the significance of the endoscope's contribution to CDCR © 2020 ARS-AAOA, LLC.

Application of a symptoms score questionnaire after conjunctivodacryocystorhinostomy: outcomes

“…In our series, there were significantly more females subjected to CDCR (75%) with a mean age, similar to other studies, of 53 years 10,11 . The demographic characteristics of our cohort were consistent with the current literature 12 . Acquired NLDO is most commonly encountered in women in their 50's or older, which seems to be related to the narrowness of the bony nasolacrimal canal and the acute angle between the bony canal and the nasal floor possibly predisposing women to chronic inflammation of the nasolacrimal drainage system 13 .…”

“…This subgroup underwent primary CDCR (p = 0.011) significantly more often, most likely due to a lack of evidence of concurrent disease on which to intervene to resolve the underlying cause. In a recent systematic review published by Eisenbach et al 12 on 54 articles and 2372 patients, the authors reported a similar distribution among the different aetiologies, although our group did not include any case of post-traumatic or cancer related stenosis. In our retrospective study, we decided to employ NLDO-SS to assess patient satisfaction after an anatomically and surgically successful CDCR procedure.…”

Multidisciplinary approach to lacrimal system diseases

“…All the treatments described for proximal obstruction of the lacrimal pathway are generally performed by an ophthalmic plastic surgeon and the collaboration with an ENT is not always mandatory. However, conjunctivodacryocystorhinostomy is an approach in which the otolaryngologist can be helpful, since endoscopic assessment of the nasal cavity allows easy visualization of the correct position of the lacrimal tube and implementation of nasal co-interventions during the approach 20 . Nevertheless, these rules concern benign lesions since malignant ones require close collaboration with the ENT surgeon: in fact, even if a primary malignancy of the proximal lacrimal tract is rare, stenosis of the lacrimal pathway secondary to extrinsic compression due to sino-nasal, or-bital and cutaneous malignancy can occur and needs to be treated in a multidisciplinary manner in order to eradicate the tumor and re-establish functional eye to nose tear flow.…”

A patient with lacrimation at an otorhinolaryngologist consultation

“…Для создания сообщения между медиальным углом глаза и носовой полостью обычно используют постоянные интубационные устройства для поддержания сформированной фистулы, например трубку Лестера Джонса. Одной из распространенных трудностей в такой процедуре является неправильное расположение конца трубки в полости носа, поэтому оториноларинголог играет важную роль в обеспечении ее правильного размещения [20].…”