Outcomes of Endoscopic Dacryocystorhinostomy: Enhancing the Patency of the Rhinostomy

Abstract Endoscopic dacryocystorhinostomy (DCR) is a common procedure used to treat nasolacrimal duct obstruction, with success rates reported above 90% and minimal complications. Scarring and granuloma formation are the most common reasons for surgical failure. Silicone stents are used by most providers to maintain patency of the rhinostomy during postoperative healing. However, evidence does not support a significant improvement in long-term patency. The duration of stenting is highly variable among providers, ranging from 4 weeks to 9 months. The reasoning behind a shorter duration of stenting is that healing is nearly complete at 4 to 6 weeks, and a longer duration facilitates granuloma formation. Adjuvant therapies such as application of mitomycin C or intralesional steroids have been also described as methods for maintaining patency. Mitomycin C may have a role in revisions and complex cases but is used less in primary DCR. Local steroid therapy has shown some promise in its ability to help maintain rhinostomy patency without introducing unwanted effects.