Endoscopic assessment of the dacryocystorhinostomy ostium after endoscopic surgery

Objectives. Dacryocystorhinostomy (DCR) is currently regarded as the treatment of choice for treatment of epiphora resulting from blockage at the level of the nasolacrimal duct. There has been debate on the effect of healing on the size of the DCR ostium after surgery. The aim of this study is to determine how the size of the surgically created lacrimal ostium changes over time. Study Design: The authors conducted a prospective cohort study of unselected patients who underwent DCR from March 1999 to November 2004. Methods. Thirty-eight patients who underwent intranasal DCR were analyzed. There were 14 males and 24 females with 11 patients undergoing bilateral DCR, resulting in 49 endoscopic intranasal DCRs being analyzed. The endoscopic findings of the size of the ostia were recorded at the time of surgery and at 4 weeks, 6 months, and 12 months after surgery. There were 33 DCRs reviewed at 12 months and 16 reviewed at 6 months who did not reattend for their 12-month appointment. Analysis of variance was used to compare the difference in the ostium sizes at the end of surgery and at 4 weeks, 6 months, and 12 months after surgery. Results: The male to female ratio was 1:1.7 and the average age was 64.5 (standard deviation [SD] = 17.8 years). The ostium measured 11.8 (STD = 2.3, 95% confidence interval [CI] = 11.1-12.5) x 7.2 (SD = 1.7; 95% CI = 6.7-7.7) at the time of surgery and 10.1 (SD = 2.3; 95% CI = 9.3-10.9) X 6.4 (SD = 1.3; 95% CI = 6.0-6.9) at 4 weeks, 9.8 (SD = 2.5; 95% CI = 9.0-10.6) X 6.5 (SD = 1.5; 95% Cl = 6.0-6.9) at 6 months, and 10.1 (SD = 2.5; 95% Cl = 9.2-11.0) x 6.6 (SD = 1.6; 95% Cl = 6.0-7.1) at 12 months. Statistical analysis (analysis of variance) showed a significant shrinkage from surgery to 4 weeks but no statistical difference from 4 weeks to 6 or 12 months. Conclusion. The DCR ostium shrinks a small but significant amount in the first 4 weeks after surgery. Thereafter, the ostium. size appears to be stable. We propose that the surgical technique used in which the nasal and lacrimal mucosa is approximated results in a first intention healing with minimal ostial granulation tissue and stenosis and minimal shrinkage of the postoperative DCR ostium.