Assessment of Outcomes of Endonasal Dacryocystorhinostomy in a Tertiary Referral Center

Background Chronic dacryocystitis due to nasolacrimal duct (NLD) obstruction is a common cause of epiphora and lacrimal abscess. Endonasal dacryocystorhinostomy (Endo-DCR) offers a scarless approach with outcomes comparable to those of external dacryocystorhinostomy when performed with appropriate technique and adequate follow-up. Objectives To evaluate the surgical outcomes of Endo-DCR and to identify risk factors associated with postoperative complications and surgical failure. Methods A retrospective observational study was conducted on 60 patients (18-70 years) with chronic dacryocystitis who underwent Endo-DCR. Follow-up data were collected at the end of one week, one month, three months, and six months following surgery. Success was defined as symptomatic resolution of epiphora with patent lacrimal syringing and endoscopic stomal patency at the end of six months. Fisher’s exact test, independent t-test, and univariate binary logistic regression were used. P < 0.05 was considered significant. Results At the end of six months, patency on lacrimal sac syringing and stomal patency on endoscopy were seen in 78.3% (n = 47/60) of patients. Immediate complications were generally mild, including nasal bleeding in 3.3% (n = 2/60) and lid edema in 8.3% (5/60). Delayed complications included granulation tissue (8.3%, n = 5/60), synechiae (6.7%, n = 4/60), and stomal closure (6.7%, n = 4/60). Failure was associated with diabetes mellitus (DM) and deviated nasal septum (both p < 0.05). Deviated nasal septum (OR: 2.52) and DM (OR: 3.05) are predominant factors predicting failure. An additional insight from this study is the pattern seen with multiple concurrent risk factors. Combinations such as DM with smoking and DM with deviated nasal septum appeared to cluster among failures, suggesting a potential synergistic risk profile rather than purely additive effects. Conclusion Primary Endo-DCR achieved a high success rate in this tertiary center cohort. Deviated nasal septum and DM were associated with failure. Highlighting the importance of risk stratification, optimization of systemic disease, and concurrent management of nasal pathology to improve outcomes.