Surgical success rate comparison in functional nasolacrimal duct obstruction: Simple lacrimal stent versus endoscopic versus external dacryocystorhinostomy

Silicone tube intubation (STI) has been known as a standard treatment modality with functional nasolacrimal duct obstruction (FNDO). Recently, dacryocystorhinostomy (DCR) is suggested for FNDO treatment. However, there are no data for comparison according to the surgical types in FNDO patients. This study aimed to compare success rates of three different lacrimal drainage surgeries in FNDO patients. Consecutive patients (153 eyes) who were treated with surgical intervention due to FNDO were analyzed. Patients were divided into three groups according to the type of surgery undertaken: STI, endoscopic DCR (Endo-DCR), and external DCR (Ext-DCR). Symptomatic improvements in epiphora were evaluated using the following scoring system: 1, complete resolution (indicative of success); 2, partial resolution; and 3, no resolution or worsening of the condition. At months 3 and 6, the Endo-DCR group had the highest success rate (84.4 and 81.3 %), but there were no statistically significant differences in epiphora scoring among the patients. Epiphora was significantly improved after surgery by week 2 in the Endo-DCR group (p = 0.0339) and by week 3 in the STI group (p = 0.0161). There were no patients in the Endo- or Ext-DCR group with a score of 3 at month 6, but 4 of 6 (3.7 %) in the STI group had score of 3 at month 6 and underwent additional DCR for epiphora. Our results suggest that Endo-DCR offers the highest success rates in FNDO treatments in terms of the rapid and complete resolution of epiphora.