Nasolacrimal Duct Research Articles

Retrospective Analysis of Bicanalicular Lacrimal Silicone Tube Intubation in Patients with Congenital Nasolacrimal Duct Obstruction: A Long-term Follow-up Study.

Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in the first year of life. In addition to conservative therapy, there are several invasive methods available. The aim of this retrospective study was to conduct a long-term follow-up of bicanalicular lacrimal duct intubation as the primary intervention in a large cohort of patients with CNLDO. The electronic medical records of 487 patients with CNLDO who underwent bicanalicular tube intubation were reviewed. To determine the long-term outcomes, a telephone interview was conducted. A total of 328 eyes of 235 patients were included in the study. The median average follow-up period was 6.67 (5.58 - 8.67) years. At the time of the survey, 218 patients (92.8%) were symptom free. Mean patient satisfaction with surgical outcome was 10/10. To our knowledge, this study provides the longest follow-up of the largest patient cohort in the literature consisting of patients who underwent probing with bicanalicular lacrimal silicone tube intubation as a primary intervention for CNLDO. This study showed a high long-term postoperative success rate, with high postoperative satisfaction, few complications, and a low need for reintervention.

Endoscopic Dacryocystorhinostomy Following Nasolacrimal Drainage System Trauma and Medial Orbital Wall Reconstruction

Study Design Case series. Objective To describe the assessment and surgical approach to dacryocystorhinostomy (DCR) for patients with nasolacrimal duct obstruction (NLDO) in the presence of orbital wall hardware. Methods The pre-operative assessment, management and outcomes of two patients with secondary acquired NLDO following medial orbital wall fracture repair treated by nasal endoscopic DCR. Results Anatomical and functional success was achieved in both cases at 6 weeks post operatively without disruption of the orbital plate. There was persistent success at 1 and 3 years’ post-operatively. Conclusions Endoscopic DCR is a good option for the treatment of NLDO in patients with previous medial orbital wall fracture repair where the location of the plate may complicate the external approach.

Punctal Atresia As a Clinical Indicator of Systemic Genetic Anomalies

ABSTRACT Background Punctal atresia or agenesis (PA) is a rare congenital anomaly characterized by the absence or closure of the tear duct puncta, potentially linked to systemic genetic anomalies. The necessity of a genetic workup based solely on the presence of PA remains uncertain. This study investigates a cohort of PA patients, examining the prevalence and types of associated syndromes. Methods A retrospective medical records review of all patients diagnosed with PA at the Children’s Hospital of Philadelphia between 2009–2023 was conducted, analyzing medical histories and genetic testing results. Primary outcomes included the prevalence of systemic syndromes, while secondary outcomes focused on the variety of associated syndromes. Results Forty-four patients were included, of which 31 were male (70%) with a mean ± SD age 3.3 ± 3.3 years. Overall, 87 puncta in the study cohort were affected, and 26 cases (59%) were bilateral. Systemic abnormalities or genetic syndromes were identified in 19 patients (43%), with the most common being Ectodermal Dysplasia and Down syndrome. Additional rare syndromes were demonstrated. No significant association was found between systemic abnormalities and gender, bilaterality, or the number of puncta involved. Conclusions A high incidence of systemic syndromes (43%) was observed in the study cohort. In individuals with PA who also exhibit extraocular disease, systemic evaluation and genetic workup should be considered. Syndromic diagnoses identified in our cohort also include: Branchio-oto-renal syndrome, 22q11.2 deletion syndrome, 1q21.1 microdeletion syndrome, NF1, monosomy 4q and trisomy 6q, which represent novel associations. The lack of correlation between PA’s phenotypic severity and systemic abnormalities highlights the need to obtain a comprehensive medical history and consider a systemic workup in PA patients.

EXAMINING THE DECREASE IN SYMPTOMS IN PATIENTS WITH DACRYOCYSTORHINOSTOMY BOTH WITH AND WITHOUT SILICON INTUBATION A RANDOMIZED CONTROLLED TRIAL

Objective: To determine if dacryocystorhinostomy or silicon intubation is more effective in treating nasolacrimalduct obstructionStudy Design: A Randomized Controlled Trial StudyPlace and duration of study: This research was conducted over a six-month period, from October 9, 2021, to April 9,2022, at the Department of Clinical Ophthalmology, Khyber Girls’ Medical College, Hayatabad Medical Complex(HMC), Peshawar.Materials and Methods: The study comprised 446 patients with nasolacrimal duct blockage (NLDO). Eachpatient was split up into two cohorts. Group A had cryocystorhinostomy (DCR) with silicon intubation, whereasGroup B underwent DCR without intubation.Results: The average age of the sample was 35.1 + 9.2 years. The mean age of Group B was 35.2 + 9.1 years,whereas the mean age of Group A was 34.9 + 9.3 years (p 0.730). Group A consisted of 61.9% males and groupB had 56.5% males (p 0.248). The average number of days that symptoms persisted was 11 + 3.2 days in group Aand 10.4 + 2.9 days in group B (p 0.082). As determined by the overall remission of symptoms, group A’s efficacywas 79.4% at follow-up, whereas group B’s was 69.5% (p 0.017).Conclusion: For those with NLDO, silicon intubation significantly boosts the efficacy of DCR when compared toDCR without intubation.Key Words: Nasolacrimal duct obstruction, dacryocystorhinostomy, intubation, silicon, and efficacy.

Nasolacrimal duct Probing versus Silicone Intubation in the Treatment of Complex Congenital Nasolacrimal Duct Obstruction

Nasolacrimal duct Probing versus Silicone Intubation in the Treatment of Complex Congenital Nasolacrimal Duct Obstruction

Clinical characteristics and cytological changes in mucinous obstruction diagnosed by dacryoendoscopy

To analyze the clinical characteristics of mucinous obstruction diagnosed by dacryoendoscopy and compared the cytological changes with membranous obstruction using a modified liquid-based thin prep cytology method. A retrospective chart review was conducted on 53 eyes of 51 patients with mucus obstruction based on dacryoendoscopic findings from January 2022 to October 2022. Liquid-based thin-prep cytology was performed by irrigating the inside of the nasolacrimal drainage system with saline during dacryoendoscopy-guided silicone tube intubation. Pathological findings were analyzed through a comparison of mucinous obstruction with membranous obstruction as determined by dacryoendoscopic findings. The modified liquid-based thin prep cytology technique had a higher cytology detection rate across all cases. Mucinous obstruction exhibited a significantly higher number of successful canalicular irrigation test cases compared to membranous obstruction. In mucinous obstruction, epithelial squamous cells were more frequently detected in pre-sac obstruction, whereas columnar epithelial cells were predominant in post-sac obstruction. Inflammatory cells showed a stronger correlation with primary change and post-sac obstruction. Bacterial colonies were observed exclusively in cases of mucinous obstruction. The use of a modified liquid-based thin prep cytology method enables the examination of histopathological changes in the lacrimal passage in primary acquired nasolacrimal duct obstruction (PANDO), particularly in cases of mucinous obstruction, without the need for invasive biopsies. These findings enhance the understanding of the etiopathogenesis of mucinous obstruction, complementing knowledge of membranous obstruction in PANDO.

A New Patient-reported Outcomes Measure for Surgically Treated Epiphora: Tearing Assessment and Rating Scale-12 (TEARS-12).

No widely accepted, validated instrument currently exists to measure clinical outcomes in patients who undergo dacryocystorhinostomy (DCR) for treatment of epiphora. To develop a patient-reported outcome measure applicable to this population. Psychometric evaluations, consultation with experts, and review of the literature informed item generation of a 12-question questionnaire to incorporate the most relevant symptoms experienced by patients with nasolacrimal duct obstruction. This questionnaire, known as the Tearing Assessment and Rating Scale-12 (TEARS-12), was administered to 32 patients before and after intervention, in the form of endoscopic DCR. Statistical analysis was performed to measure internal consistency, responsiveness, and test-retest reliability. Pre-operative and post-operative TEARS-12 scores (28.2 [standard error (SE) 3.19] vs 11.8 [SE 3.25], respectively, P = 0.001) demonstrated improved patient outcome within 6 weeks following endoscopic DCR. Cronbach's alpha for the questionnaire was 0.90, indicating high overall reliability. Additionally, each question demonstrated internal reliability, with a corrected item-total correlation greater than 0.30. The intraclass correlation between the two pre-operative scores was 0.858 (P < 0.001), indicating high test-retest reliability. TEARS-12 is a statistically valid, easy-to-administer instrument to measure clinical outcomes in patients who undergo endoscopic DCR.

An Anatomical Study Using Computed Tomography, Magnetic Resonance Imaging, and Rhinoscopy of the Nasal Cavity of Domestic Cat (Felis silvestris catus L.) and Big Cats: Lion (Panthera leo leo L.), Leopard (Panthera pardus kotiya L.), and Cheetah (Acinonyx jubatus jubatus S.).

The objective of this work was to study the normal anatomy of the nasal cavity of the three species of big cats (leopard, lion, and cheetah) compared to the domestic cat through the use of computed tomography, magnetic resonance imaging, and rhinoscopy. Computed tomography allowed us to clearly visualize the entire bony and cartilaginous framework that supports the nasal cavity. Magnetic resonance imaging permitted better visualization of the soft tissues of this cavity. On the other hand, rhinoscopy enabled the direct visualization of the mucosa of the vestibule and nasal cavity, which is very useful in the diagnosis of masses or foreign bodies. Furthermore, with this technique, it has been possible to observe several small orifices from the nasolacrimal duct, the pharyngeal auditory tube, and the lateral nasal gland. Computed tomography, magnetic resonance imaging, and rhinoscopy are useful tools in analysis of the anatomical characteristics of the nasal cavity in these species.

A transconjunctival surgical technique for dacryocystotomy in dogs with foreign body-induced dacryocystitis.

The purpose of this study is to describe a simplified, less invasive dacryocystotomy technique that allows for complete inspection of the canine lacrimal sac and to retrospectively evaluate this surgical technique in a larger series of dogs. The anatomical background of the canine nasolacrimal system is described as a basis for the surgical technique. Records of dogs from 2003 to 2023 which were diagnosed with dacryocystitis due to presumed foreign body and underwent surgical exploration and removal of foreign bodies within the lacrimal sac using this technique were reviewed. Postoperative treatment and outcome were evaluated. Records of 48 dogs were included. A foreign body was discovered during the surgery or upon retrieval of the catheter in 85% of cases (41/48). An indwelling catheter was placed in 83% of cases (40/48) for a median of 21 days. At the last recheck, the nasolacrimal duct was patent in 87% of the cases (41/47). The median follow-up time was 34 days (3-1255 days). The most commonly affected breeds were Golden retrievers (11) and dachshunds (8). The following complications occurred: two dogs removed or partly removed the catheter themselves (day 7, day 14), and one dog showed marked irritation at the catheter site which had to be removed by day 10. The transconjunctival dacryocystotomy technique is simple and less invasive than other described techniques with a successful long-term outcome in the majority of cases.

Ocular manifestations of CHARGE syndrome in a pediatric cohort with genotype/phenotype analysis.

CHARGE syndrome is a rare multi-system condition associated with CHD7 variants. However, ocular manifestations and particularly ophthalmic genotype-phenotype associations, are not well-studied. This study evaluated ocular manifestations and genotype-phenotype associations in pediatric patients with CHARGE syndrome. A retrospective chart review included pediatric patients under 20 years-old with clinical diagnosis of CHARGE syndrome and documented ophthalmic examination. Demographics, genetic testing, and ocular findings were collected. Comprehensive literature review enhanced the genotype-phenotype analysis. Forty-two patients (20 male) underwent eye examination at an average age of 9.45 ± 6.52 years-old. Thirty-nine (93%) had ophthalmic manifestations in at least one eye. Optic nerve/chorioretinal colobomas were most common (38 patients), followed by microphthalmia (13), cataract (6), and iris colobomas (4). Extraocular findings included strabismus (32 patients), nasolacrimal duct obstructions (11, 5 with punctal agenesis), and cranial nerve VII palsy (10). Genotype-phenotype analyses (27 patients) showed variability in ocular phenotypes without association to location or variant types. Splicing (10 patients) and frameshift (10) variants were most prevalent. Patients with CHARGE syndrome may present with a myriad of ophthalmic manifestations. There is limited data regarding genotype-phenotype correlations and additional studies are needed.

Dynamic viscosity of the wall of the lacrimal sac in disorders of the patency of the lacrimal ducts.

To assess the dynamic viscosity of the lacrimal sac wall in patients with various origins of lacrimal duct obstruction. The study was performed in 35 cases: 21 cases with primary nasolacrimal duct obstruction (PANDO) and 14 cases with secondary nasolacrimal duct obstruction after radioiodine therapy (SALDO). The study of biomechanical properties of the lacrimal sac was carried out using a test bench. The principle of the study was to indent the sample at a given speed and record the data obtained from the sensor of the force transmitted to the sample. The area under the curve (AUC) and the peak viscosity were calculated. A qualitative characteristic of the obtained curve was given. Median AUC in patients with PANDO was 17 × 106 [6 × 106; 19 × 106] N/m2 × s, in patients with SALDO 21 × 106 [13 × 106; 25 × 106] N/m2 × s. Intergroup differences were statistically significant (p = 0,048). The median peak viscosity in PANDO patients was 29 × 106 [25 × 106; 35 × 106] N/m2, in patients with SALDO 32 × 106 [21 × 106; 41 × 106] N/m2. The qualitative characteristics of the obtained curves differed. Biomechanical properties of the lacrimal sac may vary depending on the cause of obliteration of the lacrimal ducts. The integrated dynamic viscosity is significantly higher in SALDO patients due to exposure to radioiodine compared to that in PANDO patients.

The Use of Hand-Held Digital Otoscope as a Basic Nasal Endoscopy Tool for Lacrimal Evaluation and Pedagogy Instrument

Purpose To investigate the utility of a hand-held digital otoscope for nasal endoscopy and as a pedagogy tool for residents and fellows in patients undergoing external dacryocystorhinostomy (DCR) surgery Methods A digital otoscope (MS450-NTE, Teslong Inc., USA) comprising a digital screen device and a connectible camera probe was used for performing nasal endoscopy. Inspection of nasal cavities was performed pre-, intra-, and post-operatively in sequential patients with nasolacrimal duct obstruction, who underwent DCR or lacrimal probing. Images (1920 × 1080 pixels) and videos (1280 × 720 pixels) were captured. The device was also used for training residents and fellows in performing nasal endoscopy, and to teach basic concepts. Results The digital otoscope could be used for routine outpatient nasal examination and for performing minor procedures. 53.8% (n = 13) of ophthalmology trainees had never observed nasal endoscopy and 84.6% could not identify more than one major structure correctly prior to the current training. Post-training, all trainees could independently perform nasal endoscopy with the device and 76.9% identified all structures correctly. Conclusion A digital otoscope with a camera probe is a handy tool for nasal endoscopy and pedagogy. Low-cost gadgets such as this device can effectively be used for performing outpatient nasal endoscopy when expensive endoscopes are unavailable and in peripheral healthcare centers.

Mono-canalicular Lacrimal Stent Intubation for Congenital Nasolacrimal Duct Obstruction Treatment

Background Epiphora, marked by tear overflow at the eyelid margin, is a prevalent condition in ophthalmology, affecting over 20% of infants. The causes involve hypersecretion due to anterior segment diseases or compromised lacrimal drainage systems. While congenital nasolacrimal duct obstruction (CNLDO) in children often resolves spontaneously, persistent cases may necessitate surgical intervention. The management, which includes probing, stent insertion, and dacryocystorhinostomy, remains challenging due to the miniaturized and variable anatomy of the lacrimal pathways. Objective and Aims This study aims to investigate the efficacy of mono-canalicular Lacrijet stent insertion in managing congenital nasolacrimal duct obstruction (CNLDO) in pediatric patients, particularly those aged over 24 months. It focuses on assessing success rates in cases with prior probing or no previous probing. The study aims to contribute valuable insights to the existing literature on the effectiveness of Lacrijet intubation as a management option for CNLDO. Patients and Methods A prospective observational study following 25 pediatric patients diagnosed with epiphora in an ophthalmology hospital. The procedure included using mono-canalicular Lacrijet intubation. Patients were followed for 180 days post-operatively via subjective and objective measures. Independent and paired t-tests were used for numerical variables. Chi-square was applied to check the significant association of variables with outcome. A p-value less than or equal to 5% is considered significant. Results More than half of the sample was 3-6 years of age (56%), males (52%), and had previous probing attempts (56%). Seven (28%) patients were relieved from symptoms within less than 5 days, 12 (48%) recovered within 5-9 days, and 2 (8%) patients were symptom-free after 10 days. The success rate was 84%. Only 4 patients (16%) had unsuccessful outcomes. There was no significant difference in outcome regarding patients’ age, gender, affected eye, previous probing, and site of intubation. Conclusions and Recommendations Mono-canalicular Lacrijet stent insertion appears as a simple, safe, and reliable outpatient procedure for treating CNLDO in children. Age and prior failed probing did not significantly impact success rates. Early and detailed assessments are recommended for children with epiphora, with consideration for mono-canalicular stenting. Future research could compare outcomes between probing and intubation as initial treatments for pediatric epiphora.

A cross-sectional study on the proper administration of eye medications and its determinants among outpatients attending Brhan Aini Ophthalmic National Referral Hospital in Asmara, Eritrea

ObjectiveThis study aimed to assess the administration technique of eye medications, its determinants and disposal practices among ophthalmic outpatients.DesignAn analytical cross-sectional study was conducted.SettingBrhan Aini Ophthalmic National Referral Hospital in...

A Case of Nasolacrimal Duct Obstruction Caused by a Lacrimal Sac Retention Cyst

Acquired nasolacrimal duct obstruction may result from chronic infection, lacrimal stones, anatomical variations such as aberrant ethmoid cells, facial fractures, or complications following nasal surgery. In Korea, there has been no reported case of secondary nasolacrimal duct obstruction due to a retention cyst in the lacrimal sac. Recently, the authors encountered a 65-year-old female patient who presented with epiphora, was diagnosed with a lacrimal sac retention cyst, and was successfully treated with endoscopic marsupialization.

ScRNA-Seq: First Atlas and Cellular Landscape of Lacrimal Sac: Implications in Primary Acquired Nasolacrimal Duct Obstruction Pathogenesis.

The aim of this study was to describe the transcriptional changes of individual cellular components in the lacrimal sac in patients with primary acquired nasolacrimal duct obstruction (PANDO) and attempt to construct the first lacrimal sac cellular atlas to elucidate the potential mechanisms that may drive the disease pathogenesis. Lacrimal sac samples were obtained intra-operatively during the endoscopic dacryocystorhinostomy (EnDCR) procedure from five patients. Single-cell RNA sequencing was performed to analyze each individual cell population including epithelial and immune cells during the early inflammatory and late inflammatory phases of the disease. Eleven cell types were identified among 25,791 cells. T cells and B cells were the cell populations with the greatest variation in cell numbers between the two phases and were involved in immune response and epithelium migration-related pathways. The present study showed that epithelial cells highly expressed the genes of senescence-associated secretory phenotype (SASP) and were involved in influencing the inflammation, neutrophil chemotaxis, and migration during the late inflammatory stage. Enhanced activity of CXCLs-CXCRs between the epithelial cells and neutrophils was noted by the cell-cell communication analysis and is suspected to play a role in inflammation by recruiting more neutrophils. The study presents a comprehensive single-cell landscape of the lacrimal sac cells in different phases of PANDO. The contribution of T cells, B cells, and epithelial cells to the inflammatory response, and construction of the intercellular signaling networks between the cells within the lacrimal sac has further enhanced the present understanding of the PANDO pathogenesis.

The Origin and Course of the Blood Supply to the Lower Eyelid Orbital Fat: Anatomical Study and Clinical Significance.

The aim of this study is to investigate the origin and course of the orbital fat arterial supply in the lower eyelid using traditional anatomy and three-dimensional computed tomography (CT). Twenty-seven cadaver heads were infused with mercury sulfide contrast media through the ophthalmic artery, maxillary artery, transverse facial artery, and facial artery. CT images were obtained after contrast agent injection, three-dimensional CT scans were reconstructed, and the cadaver heads were dissected. Forty-five qualified hemifaces showed that the orbital fat arterial supply in the lower eyelid originates primarily from the inferomedial muscular trunk (IMT) of the ophthalmic artery and the orbital branch of the infraorbital artery. The medial branch of the IMT terminated at the medial fat pad (35.6%) or the orbital floor (64.4%). The lateral branch terminated at the inferior oblique (IO) muscle (28.9%) or the central and lateral fat pads (17.8%). In 53.3%, the lateral branch extended to the anterior part of the lateral fat pad and terminated in the orbital wall or the zygomaticoorbital foramina. The orbital branch of the infraorbital artery coursed between the orbital floor and the orbital fat, providing supply to the IO muscle, inferior rectus (IR) muscle, nasolacrimal duct, and orbital fat. This study elucidated the origin and course of the orbital fat arterial supply in the lower eyelid, which may help to avoid reducing the blood supply of the orbital fat pedicles during surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Virtual Reality and Mixed Reality-Assisted Endoscopic DCR in Extremely Complex Lacrimal Obstructions.

To report the techniques and outcomes of virtual reality (VR) and mixed reality (MR)-assisted powered endoscopic dacryocystorhinostomy (DCR) in extremely complex lacrimal drainage obstructions. A prospective, non-randomized clinical study was performed in complex syndromic congenital nasolacrimal duct obstruction (CNLDO) and post-traumatic secondary acquired lacrimal duct obstruction (SALDO) in the setting of Le Fort fractures. All patients underwent preoperative planning in VR and intraoperative planning with a step ahead with MR assistance during the surgery. Surgery was supported by mixed reality intraoperative guidance with the use of the prearranged 3D models and real-time-rendered digital models. Parameters assessed include demographics, clinical presentation, complexities of the nasolacrimal duct obstruction, preoperative and intraoperative utility of VR and MR models, surgical techniques, complications, and outcomes. The technique is described as a proof of concept in challenging situations with Apert syndrome and traumatic SALDOs with gross malposition of the sac, and gross nasal and lacrimal anatomical deformities. The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach. Intraoperatively, MR models were present in the surgeon's view without disturbing the endoscopic procedure. Intermittently, the surgeon could pull any of the models virtually present in the operating room, slice them, rotate them, and intricately study the alterations in a stepwise manner, as the surgery proceeds. Virtual reality and mixed reality-assisted powered endoscopic DCR can be an alternate approach reserved for extremely challenging cases of complex syndromic CNLDOs and post-traumatic SALDOs. 4 Laryngoscope, 134:3508-3515, 2024.

Outcome and Complication of Paediatric Dacryocystorhinostomy at Mardan Medical Complex Ophthalmology Unit By IJISRT

Objectives: To assess the results and risks of dacryocystorhinostomy (DCR) operations on patients with nasolacrimal duct obstruction while taking into account variables like gender distribution, side involvement, anesthesia type, and long-term follow-up.  Methodology This study involved the prospective enrollment of 23 patients, all of whom gave their guardians' informed consent. Many DCR procedures were carried out, most of which were left-sided. A silicon tube was used in certain circumstances, and it was taken out after three months. Either local or general anesthesia was used, and all patients were monitored for six months following surgery in order to evaluate the results of the procedure and any problems. We extensively recorded and analyzed the gender distribution, side involvement, type of anesthesia, success rates, and complications.  Results 39% of the 23 patients who were part in the study were female, and 61% of them were male. 69.56% of DCR procedures were carried out on the left side. DCR procedures had an 88.9% success rate, with 21 out of 23 patients being successful. There were two cases of epistaxis, eleven cases of emphysema, and one case of canalicular injury among the observed complications. There were no reports of granuloma development or tube extrusion. Seven patients underwent surgery under local anesthesia, while sixteen underwent general anesthesia.  Conclusion DCR has a good success rate and a low frequency of complications when treating nasolacrimal duct occlusion. The findings highlight how crucial it is to carefully evaluate variables like the kind of anesthesia and the application of supplemental tools like silicon tubes in order to maximize surgical outcomes. For patients with nasolacrimal duct obstruction, DCR appears to be a safe and effective therapeutic option with encouraging outcomes. Larger sample numbers and longer-term follow- up are necessary for validation of these results and investigation of other factors impacting surgical outcomes.

Efficacy of adjuvant mitomycin-C and triamcinolone-impregnated nasal packing for endoscopic dacryocystorhinostomy.

To compare the success rate and complications of adjuvant use of mitomycin C and triamcinolone-impregnated biodegradable nasal packing (TABP) in endoscopic dacryocystorhinostomy (DCR). And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR. A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed. The patients were randomly divided into three groups: Group A included patients treated without intraoperative mitomycin C but with TABP, Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing, and Group C included patients treated with intraoperative mitomycin C and TABP. The results revealed no significant difference in the overall success rates between Groups A (86.8%) and B (89.2%; P=0.377). However, Group C (97.5%) showed a significantly higher overall success rate than Groups A and B. The incidence of granulomas was significantly lower in group C (5%) than in Groups A (20.8%) and B (15.2%; P=0.009). Other complications, such as crust, synechiae, and revision surgery, did not differ significantly among the three groups. The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate. Additionally, there is no statistically significant difference observed between the use of mitomycin C or TABP alone.