Endoscopic Endonasal Dacryocystorhinostomy Using an Otologic Drill: Bridging the Gap Between Objective Measures and Patient-Reported Outcomes

Year 2025, Volume: 8 Issue: 3, 97 - 104, 23.12.2025

Utku Kubilay , Süleyman Emre Cılız , Mürşit Alperen Yakut , Ozlem Yagiz Agayarov , İbrahim Çukurova

https://doi.org/10.65396/ejra.1828800

Abstract

Objective: Dacryocystorhinostomy (DCR) bypasses an obstructed tear duct, allowing tears to drain directly into the nasal cavity. Although external and endonasal DCR approaches are effective, no universally accepted technique exists. This retrospective study evaluated the efficacy of endoscopic endonasal dacryocystorhinostomy (EnDCR) performed using an otologic drill, assessed by the nasolacrimal lavage test and the Lac-Q questionnaire.
Materials and Methods: We retrospectively analysed 20 eyes from 18 patients who underwent EnDCR between April 2021 and December 2022. Pre- and postoperative assessments included endoscopic examination, nasolacrimal lavage testing and Lac-Q scoring at ≥6 months follow-up.
Results: Patients were 4 males (22.2%) and 14 females (77.8%) with a median age of 63 years. Surgery was successful in 16 eyes (80.0%) and unsuccessful in 4 eyes (20.0%). Postoperative Lac-Q scores improved significantly in the successful group, whereas complications and revision surgery were more frequent in the unsuccessful group. Symptom severity and social impact scores were strongly correlated in patients with unsuccessful outcomes.
Conclusion: EnDCR using an otologic drill achieved a high success rate. The Lac-Q questionnaire provided valuable insight beyond the nasolacrimal lavage test, underscoring the importance of incorporating patient-reported outcomes in evaluating surgical success.

Keywords

dacryocystorhinostomy , endoscopic endonasal surgery , quality of life , Lac-Q questionnaire , otologic drill , nasolacrimal duct obstruction , epiphora

Ethical Statement

This study strictly followed the principles outlined in the Declaration of Helsinki. Ethical approval was obtained from Health Sciences University Tepecik Research and Training Hospital ethics committee (Meeting date: 2023, Decision No: 03-04).

References

• 1. Purevdorj B, Dugarsuren U, Tuvaan B, Jamiyanjav B. Anatomy of lacrimal sac fossa affecting success rate in endoscopic and external dacryocystorhinostomy surgery in Mongolians. Anat Cell Biol. 2021;54(4):441–7. doi:10.5115/acb.21.081
• 2. Hartikainen J, Antila J, Varpula M, Puukka P, Seppä H, Grénman R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope. 1998;108(12):1861–6. doi:10.1097/00005537-199812000-00018
• 3. Dolman PJ. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Ophthalmology. 2003;110(1):78–84. doi:10.1016/s0161-6420(02)01452-5
• 4. Sipkova Z, Vonica O, Olurin O, Obi EE, Pearson AR. Assessment of patient-reported outcome and quality of life improvement following surgery for epiphora. Eye. 2017;31(12):1664–71. doi:10.1038/eye.2017.120
• 5. Mistry N, Rockley TJ, Reynolds T, Hopkins C. Development and validation of a symptom questionnaire for recording outcomes in adult lacrimal surgery. Rhinology. 2011;49(5):538–54. doi:10.4193/Rhino11.042
• 6. Caldwell GW. Two new operations for the radical cure of obstruction of the nasal duct with preservation of the canaliculi and an incidental description of a new lacrimal probe. N Y Med J. 1893;57:581. [Cited in: Önerci M. Dacryocystorhinostomy: Diagnosis and treatment of nasolacrimal canal obstructions. Rhinology. 2002;40(2):39–65]
• 7. Eichhorn K, Harrison AR. External vs. endonasal dacryocystorhinostomy: six of one, a half dozen of the other? Curr Opin Ophthalmol. 2010;21(5):396– 403. doi:10.1097/ICU.0b013e32833ce6ee
• 8. Linberg JV, Anderson RL, Bumsted RM, Barreras R. Study of intranasal ostium external dacryocystorhinostomy. Arch Ophthalmol. 1982;100(11):1758–62. doi:10.1001/archopht.1982.01030040738005
• 9. Pradhan P, Bhardwaj A, Mandal S, Majhi S. Double posterior based flap technique in primary endoscopic dacryocystorhinostomy with and without using powered instrument. Indian J Otolaryngol Head Neck Surg. 2017;69(4):474–9. doi:10.1007/s12070-017-1227-x
• 10. Ben Simon GJ, Joseph J, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center. Ophthalmology. 2005;112(8):1463–8. doi:10.1016/j.ophtha.2005.03.015
• 11. Gras-Cabrerizo JR, Montserrat-Gili JR, León-Vintró X, Lopez-Vilas M, Rodríguez-Álvarez F, Bonafonte-Royo S, et al. Endonasal endoscopic scalpel-forceps dacryocystorhinostomy vs endocanalicular diode laser dacryocystorhinostomy. Eur J Ophthalmol. 2012 May 8. doi:10.5301/ejo.5000157 Epub ahead of print.
• 12. Codère F, Denton P, Corona J. Endonasal dacryocystorhinostomy: a modified technique with preservation of the nasal and lacrimal mucosa. Ophthal Plast Reconstr Surg. 2010;26(3):161–4. doi:10.1097/IOP.0b013e3181b80af6
• 13. Çukurova I, Bulğurcu S, Arslan IB, Dikilitaş B. Comparison of piezosurgery and hammer-chisel in endoscopic dacryocystorhinostomy. J Craniofac Surg. 2018;29(6):1612–3. doi:10.1097/SCS.0000000000004602
• 14. Yener H, Ozcimen M. Long-term results in transcanalicular laser and external dacryocystorhinostomy. Beyoglu Eye J. 2020;5(1):22–5. doi:10.14744/bej.2019.70299
• 15. Gurler B, San I. Long-term follow-up outcomes of non laser intranasal endoscopic dacryocystorhinostomy: how suitable and useful are conventional surgical instruments? Eur J Ophthalmol. 2004;14(6):453–60.
• 16. Saratziotis A, Emanuelli E, Gouveris H, Babighian G. Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: creating a window with a drill without use of mucosal flaps. Acta Otolaryngol. 2009;129(9):992–5. doi:10.1080/00016480802495396
• 17. Trimarchi M, Resti AG, Bellini C, Forti M, Bussi M. Anastomosis of nasal mucosal and lacrimal sac flaps in endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol. 2009;266(11):1747–52. doi:10.1007/s00405-009-1002-z
• 18. Ali MJ, Iram S, Ali MH, Naik MN. Assessing the outcomes of powered endoscopic dacryocystorhinostomy in adults using the lacrimal symptom (Lac-Q) questionnaire. Ophthal Plast Reconstr Surg. 2017;33(1):65–8. doi:10.1097/IOP.0000000000000660