Etiological Factors of Failure in Endonasal Dacryocystorhinostomy

Abstract

Background: External dacryocystorhinostomy was first performed by Addeo Toti in 1904. Before, in
1893 Caldwell did mention about endonasal approach in lacrimal surgery. In 1989, the first endonasal
dacryocystorhinostomy (DCR) performed by McDonogh and Meiring. The knowledge about etiological
factor of failure of DCR would immensely help in its prevention.
Aim: To find out the causes of failure of endonasal DCR.
Materials and Method: All the cases having epiphora following endonasal DCR surgery which completed
minimum one year period irrespective of their gender were included in the study. A total of 50 cases
from otorhinolaryngology and ophthalmology having epiphora were enrolled in the study. All cases were
subjected to diagnostic as well as therapeutic endoscopy using ‘0’ degree endoscope, causes like deviated
nasal septum, intranasal synaechia, cicatricial closure as well as inadequate size or non- dependant position
of neo-ostium, inadequate sac marsupialization, etc. leading to failure were searched and corrected. All cases
were followed for six months.
Results: There were 12 male and 38 female, epiphora was commonest symptom in all cases and the least
common was redness and swelling of eyelid in 1.The most common etiological factor for failure of endonasal
DCR was inadequate ostium size in 41, followed by inadequate sac marsupialization in 31, cicatricial closure
of ostium in 26, intranasal synechia and ostium malposition in 18 each, ostium stenosis in 13, common
canalicular obstruction in 11 and deviated nasal septum in 8 cases.
Conclusion: The most common aetiological factor responsible for failure of endonasal DCR was inadequate
ostium size whereas; the least common was malpositioning of neoostium. The number of female having
failed DCR was more than three times higher than male.