Etiology of Failed Dacryocystorhinostomy

Abstract

The common causes of a DCR failure are cicatricial closure of the ostium, inadequately sized osteotomy, inadequate lacrimal sac marsupialization, common canalicular obstruction, intervening ethmoids, inappropriately placed osteotomy with respect to the lacrimal sac leading to sump syndrome, turbinoseptal synechiae in and around the ostium, inappropriate granulation tissue, and internal ostium stenosis [1–3]. Not uncommonly, multiple causes for failure may be noted. Other less common causes of failure include a deviated nasal septum and inadequately excised middle turbinate where needed. Rare causes may be occult carcinoma, bony obstruction caused by Paget’s disease, ethmoidal sinus osteoma, and soft tissue obstruction caused by inflammatory diseases like sarcoidosis and Wegener granulomatosis. Factors that have reported to be associated with higher risk of failure include small lacrimal sac opening, prolong surgery, active inflammation, inadequate or inappropriate flaps, and intra-operative prolapse of orbital fat.