Aims We report the results and clinical effectiveness of transcanalicular diode laser-assisted revision surgery for failed endoscopic endonasal dacryocystorhinostomy (EDCR).

Methods We reviewed electronic charts of 53 eyes in 51 revision surgery patients, with anatomical failure after primary EDCR.

Results The major cause of failed EDCR was membranous obstruction of the rhinostomy site (36/53 eyes, 67.9%). The second most common cause of failure was granulomatous obstruction (13/53 eyes, 24.5%). The overall success rate of the first revision surgery was 83.0% (44/53 eyes). Revision surgery for membranous obstruction (36 eyes) showed a 100% success rate, while a 50% success rate was achieved in granulomatous obstruction (13 eyes). 2 patients with synechial obstruction also showed good results (100%). Sump syndrome (two eyes) showed a 100% failure rate after revision surgery. When granuloma was the main cause of obstruction (13 eyes), the size of the granuloma was correlated with the success of revision surgery. Granuloma size was larger in failed revision surgery (p=0.002).

Conclusions A diode laser can achieve effective tissue dissection with minimal damage and is a good alternative technique for patients with membranous obstruction who had a failed EDCR. However, it may not be appropriate for large granulomatous obstruction and sump syndrome.