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External dacryocystorhinostomy for the treatment of epiphora in patients with patent but non-functioning lacrimal systems
  1. Neena Peter1,
  2. Andrew Pearson2
  1. 1 John Radcliffe Hospital, United Kingdom;
  2. 2 Royal Berkshire Hospital, United Kingdom
  1. * Corresponding author; email: neenapeter{at}yahoo.co.uk

Abstract

Aims: To assess the outcome of external dacryocystorhinostomies (DCRs) in patients with patent but non-functional lacrimal drainage systems and to identify any pre-operative clinical or dacryocystography (DCG) and lacrimal scintigraphy (LS) factors associated with successful surgery.

Methods: A retrospective study of 46 DCRs with silicone intubation performed for patients with epiphora associated with a clinically patent lacrimal drainage system. All patients underwent pre-operative DCG and LS which were evaluated for presence, site and severity of delayed clearance. DCGs were also evaluated for reflux and anatomical abnormalities. Postoperative success was determined by subjective resolution of epiphora. Patients with persistent symptoms were offered Lester Jones Tube (LJT) insertion after establishment of a patent anastomosis to syringing and normal ostium on nasal endoscopy. Statistical analysis was performed using the Chi-square and Fisher’s exact tests to determine whether there was any association between surgical outcome and pre-operative resistance to lacrimal syringing, DCG and LS findings.

Results: 29 cases (63%) reported subjective surgical success after 11 months’ average follow-up. There was a statistically significant association between increased resistance to syringing pre-operatively and successful DCR (p=0.012). Of the 17 eyes that failed, all had patent anastomoses, and 7 went on to have LJT insertion with complete resolution of symptoms.

Conclusion: The majority of patients with patent but non-functional lacrimal drainage systems will be helped by DCR surgery, with greater success rates in those with significant reflux on pre-operative syringing. For patients with residual epiphora functional success can reach 100% with subsequent LJT insertion.

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