Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy

Ophthalmology. 1998 Jun;105(6):1106-13. doi: 10.1016/S0161-6420(98)96015-8.


Objective and design: The introduction of endonasal laser dacryocystorhinostomy (ENL-DCR) in the early 1990s showed great promise of changing dacryocystorhinostomy into an elegant, minimally invasive procedure from the traditional external dacryocystorhinostomy (EXT-DCR). This prospective, randomized study compares these two operations, their success rates, surgical durations, and postoperative symptoms.

Participants: A total of 64 cases in 61 patients with primary acquired nasolacrimal sac or duct obstruction were divided into 2 subgroups by symptoms (simple epiphora and chronic dacryocystitis). These patients were randomized within both subgroups into 2 operation groups with 32 cases in each group.

Intervention: Altogether, 32 EXT-DCRs and 32 ENL-DCRs were performed. The silicone tube was removed at 6 months after surgery. The final follow-up visit was at 1 year after surgery. The patency of the lacrimal passage was investigated by irrigation, and patients were questioned about their symptoms.

Main outcome measures: The patency of the lacrimal passage to irrigation and the duration of surgery were measured.

Results: The success rate at 1 year after surgery was 91% for EXT-DCR and 63% for ENL-DCR after primary surgery. The difference was statistically significant (P = 0.016). The surgical duration for ENL-DCR was three times shorter than for EXT-DCR, the average duration being 23 minutes and 78 minutes, respectively (P < 0.0001).

Conclusions: The EXT-DCR, when compared with ENL-DCR, seems to provide superior operation results in primary acquired nasolacrimal duct obstruction.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Dacryocystorhinostomy* / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intubation / methods
  • Laser Therapy*
  • Male
  • Middle Aged
  • Nasolacrimal Duct / surgery*
  • Prospective Studies
  • Prosthesis Implantation
  • Silicone Elastomers
  • Treatment Outcome


  • Silicone Elastomers