Endoscopic Revision of Unsuccessful Dacryocystorhinostomy under Local Anesthesia

Aims: To evaluate etiological factors for unsuccessful Dacryocystorhinostomy (DCR) surgeries and surgical outcome after revisional endoscopic endonasal dacryocystorhinostomy (Re-EEDCR) surgery.

Study Design: Retrospective study.

Place and Duration of Study: Department of Oculoplastic surgery, Tilganga Institute of Ophthalmology, between December 2017 to November 2019.

Methods: All the consecutive cases of previously failed DCRs who underwent revisional endoscopic endonasal DCR under local anesthesia were included. Patients’ medical records were reviewed for demographic profile, pre and intra-operative endoscopic findings during revisional surgery, post, the outcome of surgery. The potential causative factors for unsuccessful DCR were assessed and the surgical outcome of Re-EEDCR was evaluated.

Results: A total of 15 patients, 13 (86.7%) female and 2 (13.3%) male with failed DCR, who had undergone revisional En-DCR were evaluated. The mean age at revisional surgery was 40.53 ±15.88 (range, 18-74 years). The mean duration from primary to Re-EEDCR was 19.93±31.73 months (range, 1-120). The most common causes attributed to a failure of unsuccessful DCR was intranasal adhesion 9(60%) followed by the inappropriate site of ostium 8(53.3%), inadequate marsupialization of sac 6(40%), granuloma formation 2(13.3%), and inadequate ostium site (6.6%). The overall success rate was 93.3% (14/15) without any important intra or postoperative complications.

Conclusion: The most common cause for failed DCR was intranasal adhesions. A revision surgery with endoscopic endonasal approach under local anesthesia can significantly reduce overall surgery time and avoids the risk of further skin scarring. It is a safe and an effective option in the management of unsuccessful DCR surgery.