Endoscopic endonasal dacryocystorhinostomy: is assuming topical anti-glaucoma medications a contraindication?

Abstract

Purpose Topical anti-glaucoma medications have been investigated on producing fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. The aim of the study was to assess whether these effects may impair the effectiveness of dacryocystorhinostomy (DCR) in patients affected by both glaucoma and nasolacrimal duct obstructions (NLDO).Methods Single-center observational retrospective study on endoscopic endonasal-DCR (EE-DCR) via posterior approach. Consecutive patients were enrolled in 2020–2023 and evaluated with proper questionnaires; resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score)Results 17 patients (29 operated sides) were enrolled. Preoperatively, 92.1% (n = 27/29) presented severe (Munk 3–4) epiphora and 69.0% (n = 20/29) recurrent dacryocystitis. At T1, 51.72% (n = 15/29) referred residual epiphora (Munk ≥ 1) and 17.20% (n = 5/29) dacryocystitis. At T2, 34.5% (n = 10/29) still complained epiphora (Munk ≥ 1) and 6.9% (n = 2/29) symptoms of dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted statistically significant (p < 0.05). At T2, 20 (69.0%) complete, 7 (24.2%) anatomical successes and 2 surgical failures (6.8%) were observed.Conclusions EE-DCR in patients suffering from NLDO despite the chronic uptake of anti-glaucoma topical medications guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis, appearing as a reasonable therapeutical strategy to improve disease-related quality of life.