Revisión sistemática sobre tratamiento quirúrgico de la obstrucción adquirida del conducto nasolagrimal

Objective: to evaluate if among the different surgical techniques for the treatment of acquired nasolacrimal duct obstruction in adults, any of them offers superiority in terms of anatomic-functional results. Methods. Systematic review following PRISAM guidelines, where only systematic reviews and meta-analyses published between January 2020 and December 2024 were included. Pediatric or congenital studies were excluded. A descriptive analysis was performed, evaluating the number of studies found, number of cases, predominant sex, type of intervention, follow-up time, age of participants, functional success. Effectiveness was evaluated by analyzing mainly the functional outcomes reported in the studies. Results. Nine papers were included and together 237 studies were analyzed. The different procedures used were: external dacryocystorhinostomy (DCR), endoscopic, balloon dacryoplasty, transcanalicular diode DCR and conjunctivo-DCR (C-DCR). Also one study compared the use of anesthesia and the different techniques, with or without antimetabolites (two studies), with or without silicone implant (tube). DCR (external or endoscopic) with antimetabolites showed the best functional outcome. Functional success was 90.8 % for endoscopically assisted C-DCR and 87.7 % for C-DCRS without endoscopic assistance. Conclusion. External or endoscopic DCR, used in combination with antimetabolites, is currently the best surgical option to functionally resolve acquired nasolacrimal duct obstruction. In a case with previous nasal disease, endoscopic DCR with silicone tube implantation is more effective in functional recovery.