Clin Exp Otorhinolaryngol.  2017 Mar;10(1):85-90. 10.21053/ceo.2016.00192.

Cause and Management of Patients With Failed Endonasal Dacryocystorhinostomy

• Baek JS
• Jeong SH
• Lee JH
• Choi HS
• Kim SJ
• Jang JW

• KMID: 2376413
• DOI: http://doi.org/10.21053/ceo.2016.00192

Abstract

OBJECTIVES
Endonasal dacryocystorhinostomy (DCR) is a well-established treatment method in patients with nasolacrimal duct obstruction. However, there are a few reports about the overall management of failed endonasal DCR. We investigated the causes and management strategies of failed endonasal DCR.
METHODS
This retrospective review included 61 patients (61 eyes) who had undergone revision surgery by the same surgeon after failed endonasal DCR between January 2008 and December 2012. The appropriate revision method was determined after analysis of the etiology of failure by the fluorescein dye disappearance test, nasal endoscopy, lacrimal irrigation, and probing. The criteria for success of the revision surgery were defined by the passage of fluid without resistance upon lacrimal irrigation and normalization of the tear meniscus height.
RESULTS
The mean duration between the primary endonasal DCR and revision surgery was 15.3 months. The average follow-up period after revision surgery was 12.2 months. The most common cause of endoscopic revision surgery was membranous obstruction. Endoscopic revision surgery was performed in 48 patients, while lacrimal silicone tube intubation under endoscopy was performed in 13 patients. The most common indication for lacrimal silicone tube intubation was functional epiphora. The overall success rate of the revision surgery was 89%.
CONCLUSION
The most common cause of failed endonasal DCR was membranous obstruction. When patients with failed endonasal DCR presented at the clinic, it is important to identify the cause of the failure. Revision surgery could increase the final success rate of endonasal DCR.

Keyword

Failed Endonasal Dacryocystorhinostomy; Revision Surgery; Functional Epiphora

MeSH Terms

Dacryocystorhinostomy*
Endoscopy
Fluorescein
Follow-Up Studies
Humans
Intubation
Lacrimal Apparatus Diseases
Methods
Nasolacrimal Duct
Retrospective Studies
Silicon
Silicones
Tears
Fluorescein
Silicon
Silicones

Reference

1. Woog JJ, Kennedy RH, Custer PL, Kaltreider SA, Meyer DR, Camara JG. Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2001; Dec. 108(12):2369–77.

2. Leong SC, Macewen CJ, White PS. A systematic review of outcomes after dacryocystorhinostomy in adults. Am J Rhinol Allergy. 2010; Jan-Feb. 24(1):81–90.

3. Hull S, Lalchan SA, Olver JM. Success rates in powered endonasal revision surgery for failed dacryocystorhinostomy in a tertiary referral center. Ophthal Plast Reconstr Surg. 2013; Jul-Aug. 29(4):267–71.

4. Lee TS, Shin HH, Hwang SJ, Baek SH. The results of revisional surgery for the failed endonasal DCR. J Korean Ophthalmol Soc. 2007; Feb. 48(2):186–92.

5. Kim NJ, Kim JH, Hwang SW, Choung HK, Lee YJ, Khwarg SI. Lacrimal silicone intubation for anatomically successful but functionally failed external dacryocystorhinostomy. Korean J Ophthalmol. 2007; Jun. 21(2):70–3.

6. Shams PN, Chen PG, Wormald PJ, Sloan B, Wilcsek G, McNab A, et al. Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy. JAMA Ophthalmol. 2014; Sep. 132(9):1127–32.

7. Mathew MR, McGuiness R, Webb LA, Murray SB, Esakowitz L. Patient satisfaction in our initial experience with endonasal endoscopic non-laser dacryocystorhinostomy. Orbit. 2004; Jun. 23(2):77–85.

8. Metson R. Endoscopic surgery for lacrimal obstruction. Otolaryngol Head Neck Surg. 1991; Apr. 104(4):473–9.

9. Ragab SM, Elsherif HS, Shehata EM, Younes A, Gamea AM. Mitomycin C-enhanced revision endoscopic dacryocystorhinostomy: a prospective randomized controlled trial. Otolaryngol Head Neck Surg. 2012; Nov. 147(5):937–42.

10. Paik JS, Cho WK, Yang SW. Comparison of endoscopic revision for failed primary external versus endoscopic dacryocystorhinostomy. Clin Experiment Ophthalmol. 2013; Mar. 41(2):116–21.

11. Weidenbecher M, Hosemann W, Buhr W. Endoscopic endonasal dacryocystorhinostomy: results in 56 patients. Ann Otol Rhinol Laryngol. 1994; May. 103(5 Pt 1):363–7.

12. El-Guindy A, Dorgham A, Ghoraba M. Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol. 2000; Apr. 109(4):425–30.

13. Zeldovich A, Ghabrial R. Revision endoscopic dacryocystorhinostomy with betamethasone injection under assisted local anaesthetic. Orbit. 2009; 28(6):328–31.

14. Korkut AY, Teker AM, Ozsutcu M, Askiner O, Gedikli O. A comparison of endonasal with external dacryocystorhinostomy in revision cases. Eur Arch Otorhinolaryngol. 2011; Mar. 268(3):377–81.

15. Choussy O, Retout A, Marie JP, Cozlean A, Dehesdin D. Endoscopic revision of external dacryocystorhinostomy failure. Rhinology. 2010; Mar. 48(1):104–7.

16. Jordan DR, Brownstein S, Lee-Wing M, Ashenhurst M. Pyogenic granuloma following oculoplastic procedures: an imbalance in angiogenesis regulation? Can J Ophthalmol. 2001; Aug. 36(5):260–8.

17. Apuhan T, Yıldırım YS, Eroglu F, Sipahier A. Effect of mitomycin C on endoscopic dacryocystorhinostomy. J Craniofac Surg. 2011; Nov. 22(6):2057–9.

18. Ozkiris M, Ozkiris A, Goktas S. Effect of mitomycin C on revision endoscopic dacryocystorhinostomy. J Craniofac Surg. 2012; Nov. 23(6):e608–10.

19. Cheng SM, Feng YF, Xu L, Li Y, Huang JH. Efficacy of mitomycin C in endoscopic dacryocystorhinostomy: a systematic review and meta-analysis. PLoS One. 2013; May. 8(5):e62737.

20. Ozsutcu M, Yenigun A, Meric A, Ozucer B, Dogan R, Gulkilik G, et al. Transcanalicular revision surgery for failed dacryocystorhinostomy. Clin Ter. 2013; 164(6):e485–8.

21. Derya K, Demirel S, Doganay S, Orman G, Cumurcu T, Gunduz A. Endoscopic transcanalicular diode laser dacryocystorhinostomy: is it an alternative method to conventional external dacryocystorhinostomy? Ophthal Plast Reconstr Surg. 2013; Jan-Feb. 29(1):15–7.

22. Balikoglu-Yilmaz M, Yilmaz T, Taskin U, Taskapili M, Akcay M, Oktay MF, et al. Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser. Ophthal Plast Reconstr Surg. 2015; Jan-Feb. 31(1):13–8.

23. Desiate A, Cantore S, Tullo D, Profeta G, Grassi FR, Ballini A. 980 nm diode lasers in oral and facial practice: current state of the science and art. Int J Med Sci. 2009; Nov. 6(6):358–64.

24. Kamel R, El-Deen HG, El-Deen YS, El-Hamshary M, Assal A, Farid M, et al. Manometric measurement of lacrimal sac pressure after endoscopic and external dacryocystorhinostomy. Acta Otolaryngol. 2003; Jan. 123(2):325–9.

25. Detorakis ET, Drakonaki E, Papadaki E, Pallikaris IG, Tsilimbaris MK. Watery eye following patent external DCR: an MR dacryocystography study. Orbit. 2010; Oct. 29(5):239–43.

26. Delaney YM, Khooshabeh R. Fluorescein transit test time and symptomatic outcomes after external dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2002; Jul. 18(4):281–4.

27. Al-Qahtani AS. Primary endoscopic dacryocystorhinostomy with or without silicone tubing: a prospective randomized study. Am J Rhinol Allergy. 2012; Jul-Aug. 26(4):332–4.

28. Feng YF, Cai JQ, Zhang JY, Han XH. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol. 2011; Dec. 46(6):521–7.

29. Smirnov G, Tuomilehto H, Terasvirta M, Nuutinen J, Seppa J. Silicone tubing is not necessary after primary endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol. 2008; Mar-Apr. 22(2):214–7.