PROSPECTIVE RANDOMIZED COMPARISON OF EXTERNAL DACRYOCYSTORHINOSTOMY AND ENDONASAL LASER DACRYOCYSTORHINOSTOMY

Objective and Design: The introduction of endonasal laser dacryocystor hinostomy (ENL-DCR) in the early 1990s showed great promise of changin g dacryocystorhinostomy into an elegant, minimally invasive procedure from the traditional external dacryocystorhinostomy (EXT-DCR). This pr ospective, randomized study compares these two operations, their succe ss rates, surgical durations, and postoperative symptoms. Participants : A total of 64 cases in 61 patients with primary acquired nasolacrima l sac or duct obstruction were divided into 2 subgroups by symptoms (s imple epiphora and chronic dacryocystitis). These patients were random ized within both subgroups into 2 operation groups with 32 cases in ea ch group. Intervention: Altogether, 32 EXT-DCRs and 32 ENL-DCRs were p erformed. The silicone tube was removed at 6 months after surgery. The final follow-up visit was at 1 year after surgery. The patency of the lacrimal passage was investigated by irrigation, and patients were qu estioned about their symptoms. Main Outcome Measures: The patency of t he lacrimal passage to irrigation and the duration of surgery were mea sured. Results: The success rate at 1 year after surgery was 91% for E XT-DCR and 63% for ENL-DCR after primary surgery. The difference was s tatistically significant (P = 0.016). The surgical duration for ENL-DC R was three times shorter than for EXT-DCR, the average duration being 23 minutes and 78 minutes, respectively (P < 0.0001). Conclusions: Th e EXT-DCR, when compared with ENL-DCR, seems to provide superior opera tion results in primary acquired nasolacrimal duct obstruction.