External Versus Endoscopic Dacryocystorhinostomy for Recurrent Dacryocystitis after Endoscopic Dacryocystorhinostomy

Abstract Purpose The aim of this study was to retrospectively compare the clinical effects of external dacryocystorhinostomy (EX-DCR) and endoscopic dacryocystorhinostomy (EN-DCR) on recurrent dacryocystitis after EN-DCR. Methods Thirty cases involving thirty eyes with post-EN-DCR recurrent dacryocystitis in our hospital between January 2015 and December 2018 were analyzed retrospectively. All of the patients underwent routine preoperative examination, including probing and irrigation of the lacrimal passage, nasal endoscopy, and maxilla-facial computed tomography scanning. Patients with nasal adhesions, nasal tumors and severe deviation of the nasal septum were excluded. Under general anesthesia, twelve patients underwent EN-DCR, and eighteen patients experienced EX-DCR under general anesthesia. Anti-inflammatory treatment was carried out after surgery for one week. The medical records of all the patients were tracked for one year. Results At the third month, all of the EN-DCR patients achieved good results with unobstructed lacrimal irrigation after removal of the bicanalicular tube stents. Sixteen EX-DCR patients had patency of the lacrimal passage, while two other patients exhibited obstructed lacrimal passage. However, at the twelfth month, ten EN-DCR patients had an obstructed lacrimal passage again, and there were only two patients remaining patency in lacrimal duct with a (success rate of 16.7%). In contrast, among the eighteen EX-DCR patients, fifteen cases achieved success with smooth irrigation of the lacrimal passage with a (success rate of 83.3%). There was a statistically significant difference between the two groups in the success rate for the longer follow-up period. No major intra- or post -treatment complications occurred. Conclusions EX-DCR is effective and safe with a higher success rate for the treatment of recurrent dacryocystitis after EN-DCR and might be considered as a primary compensate therapy for EN-DCR.