Clinical Profile and Surgical Outcomes of External Dacryocystorhinostomy in a Public Tertiary Training hospital in the Philippines

Background. External dacryocystorhinostomy (DCR) is the most commonly performed major procedure for relieving primary acquired nasolacrimal duct obstruction. Local data on the clinical profile of these patients, surgical success rate, and complications encountered are lacking; hence the need for baseline institutional data. 

Objective. The primary objectives were to determine the surgical success rate of external dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction in a public tertiary training hospital and describe their clinical profile. The secondary objectives were to identify the most common postoperative complications and patient or surgeon factors that may affect outcomes of surgery.

Methods. A single-center retrospective cohort study including 331 cases of primary external dacryocystorhinostomy was done from January 2011 to June 2019. Patient charts were reviewed for age, sex, history of dacryocystitis, duration of tearing, comorbidities, surgeon level of training, and duration of silicone tube intubation. Functional outcome in terms of presence of epiphora postoperatively and anatomical outcome, which depended on lacrimal apparatus irrigation or dye disappearance test done postoperatively, were included in the review of patient charts. Statistical analysis was done using the Mann-Whitney U test, chi-square test, and univariable and multivariable binary logistic regression analysis.

Results. The functional and anatomic success rates of primary external DCR at 3 months postoperative were 95.77% and 97.58%, respectively, and 93.05% functionally and 91.90% anatomically at six months. The median age for the patients was 59 years old, and predominantly female. There was insufficient evidence to conclude any significant differences in the following characteristics between those who had functional success and those who had functional failure, such as age, history of dacryocystitis, duration of tearing, presence of comorbidities such as hypertension, diabetes mellitus, tuberculosis, hyperthyroidism, bronchial asthma and allergies, the level of training of the surgeon, and the laterality of the procedure. Our data showed a higher rate of functional failure among males and those who had shorter silicone tube intubation times.

Conclusion. Primary external DCR in our setting achieved excellent surgical success rates and low complication rates. Surgical failure remained its most common complication, and apart from it, the other common complications were minor and were conservatively managed. The length of silicone tube intubation time may have contributed to surgical success, which warrants prospective confirmation.