Surgical outcomes of endoscopic dacryocystorhinostomy for eyes with nasolacrimal duct obstruction via tear meniscus height evaluation

Purpose: To evaluate clinical outcomes of patients who underwent endonasal dacryocystorhinostomy (En-DCR) and investigate prognostic factors. Methods We recruited 304 patients from two institutes. The tear meniscus height (TMH) was measured using anterior segment optical coherence tomography before surgery. All patients underwent endoscopic DCR with lacrimal intubation stent insertion. The lacrimal stent was removed 2 months after surgery. The TMH was measured 2 months and 12 months after surgery. Improvements in epiphora were assessed using a visual analogue scale (range, 0–2). Recurrence was determined based on lacrimal irrigation and endoscopic evaluation results. Results All patients experienced improvements in subjective symptoms 2 months after surgery. The mean TMH also decreased significantly compared with that before surgery. During the follow-up period, four patients experienced recurrence. The mean TMH 12 months after surgery was significantly lower than that before surgery. The rate of change in the TMH was significantly associated with the use of a dacryoendoscope during sheath-guided lacrimal stent intubation at all time points. Of the 251 patients who were followed up at 12 months after surgery, three reported recurrences, and 17 reported mild improvement of epiphora. The rate of change in the TMH was significantly associated with epiphora improvement. Height was also associated with epiphora improvement. Conclusions Endoscopic DCR is an acceptable surgical procedure for managing nasolacrimal duct obstruction. Sheath-guided lacrimal stent intubation using a dacryoendoscope decreases postoperative TMH more than blind insertion, which may lead to favourable clinical outcomes.