Randomized, double-blind, controlled study to evaluate the effect of vidian nerve cauterization on lacrimation.

Abstract

After vidian neurectomy, low reported rates of dry eye syndrome (DES) seemed incompatible with the high success rate of nerve severance in previous studies. This study aimed at understanding of the pathophysiology of lacrimation and evaluating the effect of thermal injury through the distal stump on the sphenopalatine ganglion (SPG) after vidian neurectomy. A randomized, double-blind, controlled study was performed to evaluate the DES. Eighty precise vidian neurectomies were randomized in a 1:1 ratio to groups 1 and 2. Group 1 represented the cauterization and was used in both distal and proximal nerve stumps, whereas only the proximal nerve stump was cauterized in group 2 subjects. The DES was evaluated with Schirmer's test and ocular surface disease index (OSDI) before and after surgery at 7-10 days and 30 days, respectively. In group 1, the Schirmer's test showed a mean decline of 20 mm (20/30, 66%) at 7-10 days and 15 mm (15/30, 50%) at 30 days. In group 2, the Schirmer's test revealed significantly lesser dry eye problems, with a mean decline of 16 mm (16/30; 52%) at 7-10 days and 2 mm (2/30; 6%) at 30 days. The significantly less postoperative dry eye problems in group 2 can be shown by the OSDI at 7-10 days, but not at 30 days. The mean follow-up period was 24 months. No recurrence of nasal allergy symptoms was noted in the follow up period. The significant advantage of preservation of the SPG function is justified by Schirmer's test, although the effect did not appear to be comparable with the clinical manifestations evaluated by OSDI at 30 days. Nevertheless, the preservation of distal stump from preventive cauterization can still offer better eye ball moisture in the early evaluation of DES.