External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost

Ophthalmology. 1995 Jul;102(7):1065-70. doi: 10.1016/s0161-6420(95)30910-4.


Background: External dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, with success rates consistently above 90%. This study reviews the demographics, success, cost, efficiency, and patient satisfaction in external DCR. This information will be useful as comparison criteria for evaluating new surgical techniques.

Methods: Records of 169 external DCR procedures performed over an 8.7-year period were reviewed. All patients had preoperative symptoms of tearing and/or dacryocystitis with a component of nasolacrimal obstruction. Patient demographics, history, examination findings, surgical and anesthesia information, postoperative success, complications, and follow-up course were recorded. Patient satisfaction and long-term success were evaluated by telephone survey.

Results: External DCR often required middle turbinectomy (17%), exposure of ethmoid sinuses (17%), and removal of dacryoliths (14%). Most patients (90%) underwent silicone intubation, with the tubes removed at an average of 3.7 weeks after surgery. A patent system was established in 95% of procedures, whereas 92% remained asymptomatic. Postoperative complications included hemorrhage (3.9%) and scarring (2.6%). Of the surveyed patients, 87% denied continued or recurrent symptoms; 97% rated their incision "good" to "excellent" in appearance; and all patients stated they would recommend the procedure to others.

Conclusion: External DCR is highly successful, requires limited follow-up, and is a cost-effective procedure. Complications are uncommon, and patient satisfaction is high. New lacrimal surgical techniques must be evaluated against the long-proven success of the external approach.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Dacryocystorhinostomy* / economics*
  • Female
  • Follow-Up Studies
  • Humans
  • Lacrimal Duct Obstruction / economics*
  • Male
  • Middle Aged
  • Nasolacrimal Duct / surgery*
  • Patient Satisfaction*
  • Postoperative Complications
  • Retrospective Studies
  • Treatment Outcome