Experience with endoscopic dacryocystorhinostomy using four methods

Abstract

Objective Evaluation of four methods of endoscopic dacryocystorhinostomy (EDCR) for treating chronic dacryocystitis. Study Design Case series with chart review. Materials and Methods A total of 1450 patients underwent EDCR for epiphora, chronic dacryocystitis, and blocked nasolacrimal ducts. Relief from epiphora, dacryocystitis, and patency of the fistula for all four techniques was compared. A total of 292 patients underwent incision and drainage, 343 patients had grommets inserted, 258 had silastic lacrimal stents inserted, and 557 had the medial wall of the lacrimal sac (LS) removed. Parameters of success were 1) resolution of epiphora, 2) no further attacks of dacryocystitis, and 3) patency of the new fistula. Results Sixty-five percent failed the incision method, and 68 percent of the patients who underwent the grommet method failed. All 258 patients with lacrimal stents experienced success while the stent remained in situ. Ten patients required removal because the stents created corneal opacities. One required removal because of a foreign body granuloma at the punctum. Only eight (1.4%) patients with removal of the LS failed. On multivariate analysis, female sex (OR = 5.6) was found to be associated with a higher rate of failure. Incision and drainage (OR = 100.1) and grommet insertion (OR = 60.6) were associated with increased risk of failure. Removal of the medial wall of the LS (OR = 0.069) and findings of a clear sac (OR = 0.001) or mucus (OR = 0.204) were associated with success. Conclusion The best EDCR results are achieved by stenting or removal of the medial wall of the LS. In our experience, excision of the medial wall of the LS was as successful as insertion of silastic lacrimal intubation stents, without the disadvantage of causing corneal opacities.