Comparison of Endonasal Endoscopic versus External Dacryocystorhinostomy Results for Adult Patients with Acquired Nasolacrimal Duct Obstruction

Epiphora is one of the most common complaints of the patients referred to ophthalmology clinics and primary nasolacrimal duct obstruction is the main respective cause in adults. Dacryocystorhinostomy (DCR) is the surgical treatment of epiphora that can be done by two basic external and endonasal (Microscopic or Endoscopic)، and the endoscopic method is minimally invasive and without scar on the face. To compare the results and complications of these two methods in treatment of the patients with primary nasolacrimal duct obstruction. This cross sectional case control study was performed in Amir-al-Momenin university Hospital of Rasht، Iran during 2008-10. Ninety-one patients (88 women and 3 men) were recruited in two groups: external (N= 46) and endoscopic DCR (N= 45). After surgery، all the patients were followed for 6-12 month periods and results and complications were studied in each group. Surgery failure was defined as: no marked improvement in tearing or any episode of postoperative dacryocystitis، postoperative nasal endoscopy with scarring in the intranasal osteotomy، and no visualization of fluorescein dye in nasal endoscopy of the participants. Also، two groups were compared in the average time of fluorescein excretion into the nose. Results were analyzed using SPSS 17 software، and the level of significance was set at 0. 05. Success was achieved in 92. 3% of all patients، 93. 5% in the external group and 91. 1% in the endoscopic group (P= 0. 672). The average visual analogue scale (VAS) score for subjective improvement of epiphoria in both external and endoscopic DCR groups was 8. The mean time of excretion of fluorescein dye into the nose in external and endoscopic groups were 21. 3 ± 26. 7 seconds and 10. 4 ± 12. 1 seconds، respectively (P= 0. 05). Endonasal endoscopic DCR has comparable success rates with external DCR، and it seems that the pump function of lacrimal sac is better saved in endoscopic method، meanwhile،the loss of scar and minimal surgical invasion and complicatios are other advantages of this method over the other.