Abstract

Background: Dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction. The purpose of the current study was to evaluate functional/ anatomic success for endoscopic versus external dacrocystorhinostomy (DCR) surgeries in nasolacrimal duct obstruction (NLDO) at newly established tertiary care centre.
Materials& Methods: A hospital based prospective study done on 100 patients with complaining of excessive tear formation in department of ophthalmology & Otorhinolaryngology at Government Medical College Pali, Rajasthan, India during one year period. Documented obstruction on syringing and probing or obstruction on lacrimal scintigraphy were used in the diagnosis of NLDO. Patients with previous DCR surgery to the same eye were excluded from the study. Success was defined as full resolution of symptoms and no postoperative dacryocystitis without additional postoperative lacrimal duct surgery. Regarding the analysis of long-term outcome, only the first side was included in bilateral cases. Patients were also asked to rate their satisfaction on a scale of 1 to 10 (1 = extremely dissatisfied to 10 = extremely satisfied).
Results: Demographics between the two surgical groups were similar. There was no statistically significant difference in comorbidities, previous sinus disease or surgery, ocular history, or presenting symptoms. 94 had unilateral DCR (right side, 48 (51.06%); left side, 46 (48.93%)), and 6 patients had bilateral DCR. The complication incidence was low and similar in both operations. Two patients had postoperative hemorrhage (one who had endonasal DCR surgery and one having external DCR surgery). Seven patients who underwent DCR surgery had tubes that fell out before the 2-month assessment, of which three were in the endonasal group and four in the external group. There was no statistical significance between the external DCR group and the endoscopic endonasal group (P >0.05). The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.8%, compared to 83.5% for patients without previous episodes of dacryocystitis. The difference was not statistically significant (P>0.05). The success rate in patients without previous lacrimal duct surgery was 88.6% compared to 74.4% for patients with previous lacrimal duct surgery. The difference was also not statistically significant (P>0.05).
Conclusion: The advantage of endoscopic surgery is that it leaves no scar and preserves the lacrimal pump system, unlike external DCR. Choice in regards to surgical techniques should depend on patient preference, with consideration given on the availability of resources amongst health care systems.