Surgical outcomes of endonasal dacryocystorhinostomy according to the level of obstruction in dacryocystography

Purpose: The success of endonasal dacryocystorhinostomy was assessed according to the level of tear duct obstruction in dacryocystography. Methods: Patients visited our clinic with the chief complaint of epiphora between January 2009 and September 2016 who received dacryocystography and were diagnosed with a total nasolacrimal obstruction. Among these patients, 128 eyes from 115 patients who received endonasal dacryocystorhinostomy were selected and their medical records from > 6-month follow-ups were analyzed retrospectively. The patients were divided into four groups according to the level of lacrimal passage obstruction in dacryocystography: common canaliculus obstruction as group 1, lacrimal sac obstruction as group 2, lacrimal sac-nasolacrimal duct junction obstruction as group 3, and nasolacrimal duct obstruction as group 4. Success and failure were determined according to symptom improvements after surgery. Results: Among the total of 128 eyes, 19 eyes were categorized as group 1 (22.6%), 28 eyes as group 2 (21.9%), 28 eyes as group 3 (21.9%), and 43 eyes as group 4 (33.6%). Nasolacrimal duct obstruction was the most common condition. The success of endonasal dacryocystorhinostomy was 55.2% in group 1, 71.4% in group 2, 85.7% in group 3, and 86.1% in group 4. The surgical success of the patient group with common canaliculus obstruction was significantly lower than the surgical success of the lacrimal sac-nasolacrimal duct junction obstruction and nasolacrimal duct obstruction groups (p = 0.03 and p = 0.01, respectively). Conclusions: Determination of the accurate position of obstruction using preoperative dacryocystography is recommended for patients with epiphora caused by tear duct obstruction because this predicted the effects of endonasal dacryocystorhinostomy.