Functional and anatomic results after two types of endoscopic endonasal dacryocystorhinostomy: Surgical and holmium laser

Abstract Purpose To determine subjective and objective outcomes after two types of endoscopic endonasal dacryocystorhinostomy (DCR) and to evaluate the use of the functional endoscopic dye test (FEDT). Design Prospective, nonrandomized trial. Participants Sixty-nine consecutive adult patients with primary acquired nasolacrimal duct obstruction. Methods Patients underwent primary endonasal surgical or laser (Holmium:yttrium-aluminum-garnet [YAG]) DCR with temporary silicone intubation. Main objective measures Data were collected 6 months after surgery (at least 3 months after removal of tubes). Subjective results were based on the patients' symptoms of epiphora. Objective results consisted of (1) lacrimal system irrigation, (2) FEDT—this test is positive when dye placed in the conjunctival fornix is observed to enter the nasal space via the DCR rhinostomy, and (3) rhinostomy appearance. Results Thirty-six patients had endosurgical and 33 had endolaser (Holmium:YAG) DCR. Symptomatic success was 83% after endosurgical and 71% after endolaser DCR. Lacrimal irrigation was a good test after surgery for identifying patients with successful or unsuccessful outcome (sensitivity, 98%; specificity, 87%). The FEDT had a few false negatives and small number of false positives (sensitivity, 83%; specificity, 91%). Conclusions Endoscopic endonasal DCR performed surgically had better results than those achieved with Holmium:YAG laser alone (but did not reach statistical significance). The FEDT is useful in assessing rhinostomy patency and understanding the effects of surgery but was not as good as lacrimal irrigation in predicting symptomatic success.