Comparative outcomes of endoscopic dacryocystorhinostomy under local versus general anesthesia in elderly patients

Endoscopic dacryocystorhinostomy (DCR) is a common procedure, typically performed under general anesthesia (GA), while performing it under local anesthesia (LA) may offer benefits to elderly or high-risk patients. This study evaluates the feasibility and surgical outcomes of endoscopic DCR under LA, with comparison to GA. This retrospective cohort study included patients aged 18 years or older with acquired nasolacrimal duct obstruction who underwent Endoscopic DCR at a tertiary referral center between January 2019 and December 2024. Surgical outcomes were evaluated using multivariable Cox proportional hazards models adjusted for age and sex, with propensity score–matched analyses as sensitivity analyses. Secondary outcomes included operative time, intraoperative bleeding, complications, predictors of failure and revision surgery. Furthermore, potential predictors were screened by univariable analyses, and variables with P < 0.15 were entered into multivariable models. The study enrolled 210 eyes of 162 patients, with 117 patients (159 eyes) in the GA group, and 45 patients (51 eyes) in the LA group. The mean age was 61.7 ± 12.2 years in the GA group, and 72.3 ± 12.7 years in the LA groups. Surgical success was comparable between groups, with the LA group exhibiting a shorter operative time ( P < 0.001). No major adverse events were reported. Small lacrimal sac size was identified as an independent associated factor of surgical failure ( P < 0.001). LA offers a feasible alternative to GA for endoscopic DCR, particularly in elderly patient. Potential drawbacks include patient discomfort and an uncontrollable surgical field, which can be mitigated with appropriate patient selection.