The Impact of Nasal Pathologies on the Success of External Dacryocystorhinostomy

Background External dacryocystorhinostomy (Ex-DCR) is a widely used surgical procedure for nasolacrimal duct obstruction, but its success may be influenced by coexisting nasal pathologies. Preoperative evaluation with paranasal sinus computed tomography (CT) can assist in surgical planning and decision-making. Purpose To identify nasal pathologies in patients who underwent Ex-DCR with bi-canalicular silicone tube intubation for dacryostenosis by reviewing their paranasal sinus CT scans and to evaluate the impact of these pathologies on surgical success. Method We retrospectively analyzed 78 patients with paranasal sinus CT. Nine patients underwent bilateral operations. Patients with primary acquired chronic dacryocystitis (PACD) and revision external dacryocystorhinostomy (rE-DCR) were included in the study. All patients underwent Ex-DCR with silicone tube intubation. Anatomic success was defined as the patency of the lacrimal passage after the removal of silicone tube six months after tube intubation. The study investigated septal deviation, concha bullosa, inferior concha hypertrophy, and sinus inflammation. Results The mean age of the patients was 58.39±11.67 years, with 11 men (14.1%) and 67 women (85.9%). Eighty (92%) patients had PACD and seven (8%) patients had rE-DCR. The mean follow-up period was 2.45±2.14 years. Among these, no pathology was detected in 26 patients (29.9%). Fifty-five (90%) of 61 patients with nasal pathology had anatomical success, but in six patients, no success was achieved. There was no statistically significant difference in anatomical success between patients with and without nasal pathologies (p>0.05). There was no significant difference in anatomical success between patients with PACD and rE-DCR (p=0.09). Conclusion Ex-DCR with bi-canalicular silicone intubation remains a safe and effective treatment for nasolacrimal duct obstruction, even in the presence of common nasal pathologies. While preoperative CT can be informative, these structural nasal findings do not appear to compromise surgical success in most cases.