Endoscopic Dacryocystorhinostomy Outcomes: The Role of Obstruction Levels and Preoperative Dacryocystography.

Purpose: To determine the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) by analyzing preoperative dacryocystography (DCG) findings.

Methods: This retrospective study included 304 cases involving 197 patients. The following 6 obstruction levels on DCG were categorized: (1) patent, (2) canaliculus, (3) common canaliculus, (4) lacrimal sac, (5) duct-sac junction, and (6) nasolacrimal duct obstructions. Obstructions within the canaliculus and common canaliculus were defined as proximal obstructions, while those beyond the common canaliculus were classified as distal obstructions. The authors defined the following 2 types of success: (1) complete success, characterized by a patent ostium with no symptom of epiphora; and (2) favorable success, defined as a patent ostium with at least 50% symptom improvement.

Results: The rate of complete success varied with DCG findings, being 52.9% for patent cases and 65.5%, 70.7%, 78.9%, 81.3%, and 82.0% for canaliculus, common canaliculus, lacrimal sac, duct-sac junction, and nasolacrimal duct obstructions, respectively. The complete-success rate was lower in proximal than distal obstructions ( P =0.042). However, the favorable-success rate was 84.3% in the patent group and 94.1% for proximal obstructions, and did not differ with the DCG findings. In addition, a narrower lacrimal sac on DCG was associated with worse outcomes ( P =0.045).

Conclusions: Findings such as a small lacrimal sac indicating contracture, proximal obstructions, and patency on DCG were identified as predictors of worse surgical outcomes. However, endoscopic DCR often produces favorable outcomes even in cases with patency and proximal obstructions.