External vs. Powered Endoscopic Dacryocystorhinostomy With Mitomycin C: A Randomized Study

ABSTRACT Objective(s) To compare the 12‐month anatomical and functional outcomes of external dacryocystorhinostomy (ExDCR) and powered endoscopic dacryocystorhinostomy (EnDCR) with intraoperative mitomycin C (MMC) in patients with primary acquired nasolacrimal duct obstruction (PANDO). Methods This prospective, randomized, single‐center clinical trial assessed 133 patients with PANDO for eligibility. Eligible participants were randomized 1:1 to ExDCR or powered EnDCR. Anatomical success was defined as ostium patency confirmed by nasal endoscopy and lacrimal irrigation, whereas functional success was defined as a Munk score ≤ 1 at 12 months. Results Anatomical success was achieved in 90% of patients after ExDCR and 100% after powered EnDCR, corresponding to an absolute between‐group difference of 10 percentage points (95% CI, −3% to 26%; p = 0.237). Functional success was achieved in 87% and 97%, respectively, corresponding to an absolute between‐group difference of 10 percentage points (95% CI, −6% to 27%; p = 0.353). Complete resolution of epiphora occurred in 80% and 93%, respectively ( p = 0.254). Postoperative complications were predominantly mild and local. Conclusion Both ExDCR and powered EnDCR with intraoperative MMC achieved high anatomical and functional success rates at 12 months. Powered EnDCR showed numerically higher success rates, although the between‐group differences were not statistically significant. Trial Registration ClinicalTrials.gov : NCT07754058 Level of Evidence 2