Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy

The aim of this study was to evaluate the long-term results and the factors influencing the success in patients with nasolacrimal duct obstruction tre ated with intranasal endoscopic dacryocystorhinostomy (DCR) and silicone tu be intubation (STI). We prospectively investigated 158 patients with lacrim al obstruction in two groups, one of which comprised 108 patients treated p rimarily with intranasal endoscopic DCR by experienced surgeons and the oth er comprised 50 patients who were operated on by inexperienced surgeons. In a mean follow-up time of 49 months the surgical success was 99.4% in exper ienced hands and 58.0% in inexperienced hands. The endoscopic examination o f six patients with failure in the first group revealed granulation tissue around the tube in four, atonic sac in one and persistence of bone that was supposed to have been excised in the nasal cavity in one. There were 21 Fa ilures out of 50 patients in the second group: granulation tissue in 2 case s, fenestration to the nasolacrimal duct instead of the sac in 6 cases, syn echia between the lateral nasal wall and the middle turbinate in 2 cases, b ony spicles causing obstruction in 5 cases and fenestration anterior to the sac in 2 cases. In 3 cases no reasons were found for failure, but perhaps the small fenestration and failure to remove the medial half of the membran ous sac wall was the reason. DCR and STI can be performed for primary treat ment in lacrimal obstruction. There is a learning curve for the operation. False localization of the lacrimal sac, granulation tissue formation around the tubes, retained bony spicles, inadequate removal of the medial wall of the sac and, the synechia between the lateral wall and the middle turbinat e are the most common causes of failure.