Comparing the success rate of external dacryocystorhinostomy with anterior flap versus flap excision in managing chronic dacryocystitis

Abstract Background: Nasolacrimal duct obstruction (NLDO) is characterized by epiphora and recurrent episodes of acute dacryocystitis. Despite the temporary effect of antibiotics in the acute phase, it is primarily managed by dacryocystorhinostomy (DCR). There is a new modification of external DCR that is performed without either anterior or posterior flaps. This study aimed to compare the outcomes of flapless and single-flap external DCR in adult patients with chronic symptomatic dacryocystitis secondary to NLDO. Methods: In this retrospective, non-randomized, interventional, comparative study of patients with chronic dacryocystitis secondary to primary acquired NLDO, we compared the surgical outcomes and complication rates of flapless external DCR to those of external DCR with only anterior flap suturing. We excluded patients who declined participation and those with soft stops, nasal problems, lid margin abnormalities, lid malposition or laxity, previous lacrimal surgery, lacrimal fistula, trauma involving the lacrimal drainage system, lack of adequate follow-up, or severe septal deviation or turbinate hypertrophy. Anatomical and functional success rates were determined at the last follow-up visit and were compared. Postoperative complications were recorded and compared between groups. Results: We included ۵۳ patients with a male-to-female ratio of ۱۶ (۳۰.۲%) to ۳۷ (۶۹.۸%); ۲۵ eyes underwent flapless DCR (group ۱) and ۲۸ eyes underwent anterior flap suturing DCR (group ۲). The two groups had comparable demographic characteristics (all P > ۰.۰۵). Furthermore, anatomical (۹۲.۰% in group ۱ and ۹۲.۹% in group ۲) and functional (۸۴.۰% in group ۱ and ۹۲.۹% in group ۲) success rates at final follow-up were comparable between groups (both P > ۰.۰۵). At the one-month postoperative examination, premature tube extrusion was more often reported in group ۱ (۱۲.۰%) compared to group ۲ (۷.۱%). At the two-month follow-up examination, tube extrusion was noted in ۴.۰% in group ۱ and ۰.۰% in group ۲, yet the difference failed to attain statistical significance (P > ۰.۰۵). Conclusions: We found that neither surgical method was superior in terms of anatomical or functional success rate at a maximum of one year after external DCR. Flapless DCR is a simple, effective, and reproducible alternative to the single anterior flap suturing technique for managing NLDO in adults with chronic dacryocystitis. However, further randomized clinical trials with larger sample sizes and longer follow-up periods are recommended before generalization can be justified.