The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases.

PURPOSE: External dacryocystorhinostomy (EXT-DCR) is a surgical approach commonly used to treat post-canalicular acquired lacrimal obstruction whose success rate has been described, equally with endoscopic DCR, to be superior to other available treatments. METHODS: At San Raffaele Hospital, Milan (Italy), from January 2008 to December 2020, 245 EXT-DCRs were performed. All patients underwent routine pre-operative work-up including Jones tests and probing and irrigation of the lacrimal pathway; when necessary, a multidisciplinary approach with nasal endoscopy was performed. The surgical approach was followed by positioning of a bicanalicular stent which was left in place for 6 months. Success was defined as resolution of clinical signs/symptoms and free lacrimal flow on functional test. RESULTS: Of the cases enrolled, 26.9% were treated for recurrent epiphora (group 1), and 73.1% for epiphora associated with chronic dacryocystitis (group 2). After a median follow-up of 71 months, group 1 had success at T0 (1 month) and T1 (long-term) of 81.8% and 60.6%, respectively, compared to 93.8% and 77.7% in group 2. Statistical analysis showed a significant association with surgery both at T0 (p = 0.018) and T1 (p = 0.012) with group 2 showing better outcomes. Additionally, the cosmetic outcome of the external scar was defined as invisible in 91.8% of cases and slightly visible in 8.2%. CONCLUSIONS: External dacryocystorhinostomy provides long-term reliable results particularly in case of chronic dacryocystitis. Moreover, the optimal esthetic outcome of the external scar should be no longer considered the only guiding principle of treatment modality, particularly in the elderly.

Conjunctivochalasis as a Cause of Epiphora and its Histopathological Findings

When examining in the patients with epiphora, it is common to evaluate only the insufficiency or obstruction of lacrimal pathway by irrigation or dacryocystography and to over look the conjunctival conditions near the punctum in most cases. Authors found marked redundancy of conjunctival tissue around the punctal area in 8 patients(12 eyes) who complained of epiphora. They have neither lacrimal pathway insufficiency and obstruction, nor facial palsy or lid laxity that can impass the lacrimal pump action, and also no anatomical anomaly of the puncta. In fluorescein dye dissappearence test of these patients, the clearance of dye was markedly delayed on the lesion site(Grade 3 to 4). Epiphora was dramatically improved after simple resection of redundant conjunctiva under surgical microscope. The Hematoxylin-Eosin and Toluidine-Blue staining of resected conjunctiva revealed infiltration of many inflammatory cells and increase of metachromatic cells in the conjunctival stroma.