Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy

Abstract Objectives and Study Design: The advent of the rigid endonasal endoscope and the development of functional endoscopic sinus surgery (FESS) technique have awakened interest in an endonasal endoscopic dacryocystorhinostomy (EESC‐DCR) in treating nasolacrimal obstruction. This prospective, randomized study compares EESC‐DCR with traditional external dacryocystorhinostomy (EXT‐DCR) for their success rates, surgical duration, and postoperative symptoms. Patients and Methods: Sixty‐four cases in 60 patients with primary acquired nasolacrimal sac or duct obstruction were divided into two subgroups by symptoms (simple epiphora/ chronic dacryocystitis). These patients were randomized within both subgroups into two operation groups. Altogether 32 EESC‐DCRs and 32 EXT‐DCRs were performed. The final follow‐up visit was at 1 year. The patency of the lacrimal passage was investigated by irrigation and patients were questioned about their symptoms. Results: The success rate at 1 year after surgery was 75% for EESC‐DCR and 91% for EXT‐DCR after primary surgery. The difference was not statistically significant ( P = .18). The success rate after secondary surgery with a follow‐up time of 1 year was 97% in both study groups. The average duration for EESC‐DCR was 38 minutes, and 78 minutes for EXT‐DCR, ( P < .001). Conclusions: EXT‐DCR, when compared with EESC‐DCR, appears to give a higher, although not statistically significant, primary success rate, but the secondary success rates are equal, indicating that these two different DCR techniques are acceptable alternatives.