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Aims: To compare the outcomes of endoscopic dacryocystorhinostomy (En-DCR) in chronic dacryocystitis (CD) with or without previous bicanalicular silicone tube intubation (BSTI), and investigate whether previous BSTI influenced postoperative outcomes., Methods: We conducted a retrospective review of medical records of CD patients (group A) who had previously undergone BSTI for nasolacrimal duct stenosis and an age- and sex-matched control group of CD patients (group B) without previous intubation receiving En-DCR from November 2017 to January 2022. Sixty-one patients (61 eyes) were included in group A and age- and sex-matched 122 patients (122 eyes) in group B. Dacryocystic parameters were measured by computed tomography-dacryocystography and surgical findings were recorded during surgeries. The surgical success rates of the two groups were compared at 12 months post-operation., Results: The mean horizontal, sagittal, and vertical lengths were 6.06 ± 1.24, 6.03 ± 1.44, and 8.05 ± 2.00 mm, respectively, in group A and 6.33 ± 1.25, 6.26 ± 1.19, and 10.40 ± 2.45 mm, respectively, in group B. There were no differences in the horizontal or sagittal parameters between the two groups. The vertical parameter in group A was significantly lower than that in group B. Scar formation in the sac was observed in 54 patients in group A but was absent in group B. At 12 months postoperatively, the anatomical and functional success rates were 88.52 % and 85.25 %, respectively, in group A and 92.62 % and 89.34 %, respectively, in group B, with no difference between the two groups., Conclusion: Previous BSTI reduced dacryocyst vertical parameter and caused dacryocyst scar formation but did not affect postoperative En-DCR efficacy., Competing Interests: Declaration of competing interest The authors report no declarations of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: To compare the results of immediate endoscopic dacryocystorhinostomy (En-DCR) and delayed En-DCR in the treatment of new-onset acute dacryocystitis (AD)., Study Design: This report describes a prospective randomized controlled interventional case series., Methods: Between April 2009 and May 2019, 176 adults presenting at a tertiary eye care center with new-onset AD manifesting within the last 48 hours were randomized into two groups. Altogether, 160 patients (48 male, 112 female) were included in this study, with a median age of 52.8 years (range: 18-82). Patients in group A underwent urgent En-DCR, although those in group B underwent a delayed En-DCR after 2 to 5 days of systematic antibiotic treatment. Variables compared between these two groups included the time for resolution of acute external inflammation, free lacrimal passage reconstruction (LPR) success rates, and complication rates., Results: Postoperative data were collected from 86 patients in group A and 74 patients in group B. Patients that underwent immediate En-DCR exhibited a quicker resolution of acute inflammation (P < .05). Patients that underwent delayed surgery experienced compilations of acute inflammation, with 10 ultimately developing skin fistulization and 4 exhibiting orbital cellulitis before surgery. The success rate of LPR at 12 months after surgery was higher in group A (81/86 94.2%) relative to group B (62/74 83.8%; P < .05)., Conclusions: Immediate En-DCR is associated with quicker disease resolution and a higher long-term success rate, although reducing the incidence of complications including skin fistulization and the spread of infection., Level of Evidence: 3 Laryngoscope, 132:278-283, 2022., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: To investigate whether self-cross-linked HA hydrogel fill stimulates wound mucosal regeneration and its epithelialization around the ostia to improve long-term ostial patency in endonasal endoscopic dacryocystorhinostomy (En-DCR)., Methods: One hundred and ninety-two patients with unilateral primary chronic dacryocystitis (PCD) were randomized divided into 2 groups: group A (the HA hydrogel group) and group B (the control group). All patients underwent En-DCR. The HA hydrogel group received HA hydrogel filling the ostium at the end of the surgery and the control group received no treatment. The mucosal epithelialization of the wound, the formation of granulation, the formation of scars, and the success rate of ostial patency were compared., Results: Our study included 82 patients in group A and 79 patients in group B. At the 2-week follow up, 74 patients (90.2%) in the group A had a healed ostium with a lining of intact epithelial mucosa. It was higher when compared with 56 patients (70.9%) in group B (X2 = 9.698, P < 0.05). At the 12-month follow up, Granulation were present in 7.3% of patients in group A which was significantly lower than the 19.0% of patients in group B (X2 = 4.831, P < 0.05). No statistical difference was found with scars formation between 2 groups (X2 = 1.607, P = 0.205). The success rate of ostial patency was 89.0% (73/82) in group A and 77.2% (61/79) in group B. The success rate was much higher in group A than group B (X2 = 4.02, P < 0.05)., Conclusion: Self-cross-linked HA hydrogel may enhance the success rate of En-DCR for PCD by promoting mucosal epithelial healing and preventing excessive granulation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by Mutaz B. Habal, MD.)

Purpose: The aim of this work is to demonstrate the outcomes of endonasal dacryocystorhinostomy (En-DCR) with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing in patients with previous failed DCR., Methods: The clinical data of patients who suffered from recurrent epiphora after failed DCR between September 2014 and March 2018 were reviewed retrospectively. Among them, those who received the second En-DCR procedure were enrolled in this study. During the surgery, anterior ethmoidectomy was performed. Posterior lacrimal sac flap was apposed closely to the mucosal of anterior ethmoid sinus instead of nasal flap at end of the surgery. Patients were followed up more than 12 months were included, the success rate and complications were recorded., Results: Sixty-one eyes of 61 patients were enrolled in the study. The success rate of our modified En-DCR was 83.6% (51/61). Among 10 eyes with postoperative obstruction, 4 eyes caused by granuloma, 2 eyes caused by scar synechia, 2 eyes caused by membranous obstruction, and 2 eyes caused by common canalicular stenosis. No serious complications such as orbital fat prolapse, cerebrospinal fluid leak, sinusitis, or visual impairment were occurred in this study., Conclusion: Endoscopic approach with anterior ethmoid sinus mucosal and posterior lacrimal sac flap anastomosing is a good choice for patients with recurrent epiphora after previous failed DCR., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

Purpose: To investigate feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with an novel lacrimal ostium stent (LOS) intubation for patients with chronic dacryocystitis with small lacrimal sac., Methods: Patients diagnosed as chronic dacryocystitis with small lacrimal sac who preferred to surgery treatment between March 1st, 2012 and May 1st, 2015. All included subjects were randomly divided into 2 groups (Group A and Group B). Cases in group A were performed EE-DCR with LOS intubation while cases in group B were underwent EE-DCR without LOS intubation. Demographic data of each cases were collected. The success rate and the surgical outcomes of 2 groups were compared., Results: The success rate was much higher in group A than group B. At 3 months follow up, 61.6% of patients in group A exhibited scarring and/or granulation tissues around the ostium, which was significantly higher than the 36.4% of patients in group B. Of these patients with scars and/or granulation tissues, no statistical difference was found between 2 groups. Granuloma alone and scars with granuloma were observed in 10 patients and 2 patients, in group A and group B, respectively, resulting in a statistical significant difference for this outcome between the groups. At 9 months follow up and 12 months follow up, no significant statistical difference were found in the rate of scarring and/or granulation tissues, scars alone, granuloma alone and scars with granuloma between 2 groups., Conclusions: EE-DCR with novel LOS may be an effective procedure to manage chronic dacryocystitis with small lacrimal sac.

Purpose: The purpose of this article is to describe a modified lacrimal bypass with a porous polyethylene-coated Jones tube., Methods: A total of 180 patients (180 eyes) with a nonreconstructable lacrimal obstruction underwent lacrimal bypass with a porous polyethylene-coated Jones tube through a retrocaruncular-middle meatus tract approach with endoscopic assistance. All patients were followed up at least for 24 months. Success rate of lacrimal bypass was analyzed and complications were recorded., Results: A total of 174 patients were finally included. Duration of surgery ranged from 28 to 47 minutes (mean 37.2 ± 4.2 minutes). The mean duration of follow-up was 30.0 ± 6.4 months (range 24-48 months). The mean tube length was 23.2 ± 1.9 mm (range 20-28 mm). At the final review, complete success was achieved in 138 (79.3%) patients. Moderate success was achieved in 23 (13.2%) patients, and 13 (7.5%) patients failed. Of the 161 patients successfully treated, 24 patients underwent revision surgery to excise granulomas (15 patients) or adjust tube position (9 patients). The complications included granuloma proliferation around the openings of the tube (28 eyes), downward displacement of the tube (17 eyes), and ocular discomfort (15 eyes). The majority of downward tube migration occurred in patients who had a prior history of dacryocystorhinostomy. The treatment failed for 5 patients because of repeated granulomas covering the nasal tube openings, and the treatment failed for 8 patients because of downward displacement of the tube., Conclusions: Our procedure appears to be an effective method for closed insertion of a porous polyethylene-coated Jones.

Lacrimal sump syndrome is an uncommon cause of failed dacryocystorhinostomy. Small osteotomy was reported as the major cause of this syndrome. Here, the authors described the first case of a lacrimal sump syndrome with a large intranasal ostium following endoscopic endonasal dacryocystorhinostomy (EE-DCR). A 51-year-old women patient suffered recurrence of epiphora and dacryocystitis for 8 months following an EE-DCR. Examination showed a large intranasal ostium with a lot of purulent discharge and patent lacrimal irrigation. Lacrimal sump syndrome was diagnosed after passing a probe into the residual lacrimal sac under the aid of an endoscope. The residual sac was reopened and merogel was packed around the wound. The clinical symptoms disappeared after the surgery. It is indicated that lacrimal sump syndrome does happen not only in a small intranasal ostium, but also in a large intranasal ostium. Existing residual sac with bacterial infection may be related to this particular case.

Purpose: To study the feasibility of endoscopic endonasal dacryocystorhinostomy (EE-DCR) with novel lacrimal ostial stent (LOS) intubation for patients with chronic dacryocystitis with incarceration of a previously implanted nasolacrimal duct stent (NDS)., Methods: According to surgical procedure, 166 patients (167 eyes) were divided into two groups: EE-DCR with LOS intubation was performed on 126 patients (127 eyes) in the EE-DCR group; while external dacryocystorhinostomy (E-DCR) with silicone tube intubation was performed on 40 patients (40 eyes) in the E-DCR group. The LOS or silicone tube was retained for 3-6 months. All patients were followed up for 12-36 months. Success rate of tear drainage reconstruction (TDR) and complications were retrospectively compared., Results: Excluding patients with early detachment of the LOS or the silicone tube, or with incomplete follow-up period, 117 patients (117 eyes) in the EE-DCR group and 36 patients (36 eyes) in the E-DCR group were included. The mean surgical time was 45.8 ± 11.5 min in the EE-DCR group and 68.1 ± 23.8 min in the E-DCR group (p < 0.001). Intraoperatively, the lacrimal sac was observed to become very small and its walls were thin, hyperemic and fragile, firmly attaching to the NDS by fibrous bands in all eyes. Upon final review, success rate of TDR was 83.8% (98/117) in the EE-DCR group, while 58.3% (21/36) in the E-DCR group (p < 0.01). Failure of TDR due to ostial closure by excessive fibrosis occurred in 14 out of 19 patients in the EE-DCR group, significantly less than the 11 out of 15 patients with failed TDR in the E-DCR group (χ(2 )= 6.959, p < 0.01). No significant difference existed in failures due to granuloma occluding the ostium or common canaliculus obstruction., Conclusion: EE-DCR with LOS intubation may be an effective procedure to manage the special subgroup of patients with chronic dacryocystitis with incarcerations of a previously implanted NDS.

Purpose: To investigate the suitability of cold steel endonasal endoscopic dacryocystorhinostomy (EES-DCR) with circular bicanalicular intubation with silicone tubes (CBIST) guided by a soft probe for the primary treatment of acute purulent dacryocystitis (APD)., Design: Prospective, randomized, interventional case series., Participants: Seventy-two patients (59 females, 13 males) with a median presenting age of 55+/-12 years (range, 28-71 years)., Methods: Eighty-four patients with unilateral APD were equally and randomly divided into 2 groups. Cold steel EES-DCR was performed after the lacrimal abscess formation, and external dacryocystorhinostomy (E-DCR) was performed 1 to 2 weeks after resolution of the acute inflammation. In both groups, CBIST guided by a soft probe was performed and the silicone tubes were kept in the lacrimal passages for 3 months. Postoperative follow-up ranged from 12 to 24 months. Outcomes were compared between both groups, considering resolution time for external acute inflammation, success rate of free lacrimal passage reconstruction, and lack of complications as indicators of treatment suitability., Main Outcome Measures: Time for resolution of the external acute inflammation, success rate of free lacrimal passage reconstruction, and complications., Results: In this study, complete postoperative data were acquired from 40 patients in the EES-DCR group and from 32 patients in the E-DCR group, and the outcomes were compared. Acute inflammation resolved more quickly in the EES-DCR group than in the E-DCR group (P<0.05). Ostium patency at 12 months after silicone tube removal was achieved in significantly more patients in the EES-DCR group (36/40 [90%]) than in the E-DCR group (21/32 [65.7%]; P<0.01). In the EES-DCR group, lacrimal passage reconstruction failed because of intranasal ostial closure in 3 patients and because of common canaliculus obstruction in 1 patient. In the E-DCR group, lacrimal passage reconstruction failed because of intranasal ostial closure in 3 patients, lacrimal sac fibrosis, granulation, or both in 6 patients, and common canaliculus obstruction in 2 patients. Other than the slight laceration of the inferior puncta, no significant complications arose from the treatments., Conclusions: Cold steel EES-DCR with CBIST guided by a soft probe is a promising alternative for the primary treatment of APD with abscess formation., Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.