Buccal mucous membrane graft-assisted dacryocystorhinostomy for management of refractory acquired nasolacrimal duct obstruction

Aim The aim of this study was to evaluate the efficacy of buccal mucous membrane graft-assisted-dacryocystorhinostomy (DCR) for the treatment of refractory acquired nasolacrimal duct (NLD) obstruction. Patients and methods This is a prospective, interventional case series study that included 10 patients with acquired NLD obstruction (12 eyes), associated with expected poor mucosal flaps (either due to previous failed DCR or atrophic rhinitis). In nine eyes failed previous DCR procedures were reported, while three eyes had associated atrophic rhinitis evidenced by nasal examination. Two patients had bilateral obstruction. All eyes had symptomatic epiphora. All eyes were treated with modified DCR using a buccal mucous membrane graft. The outcome was assessed in terms of relief of epiphora, patency of irrigation testing, and patency of the osteotomy site assessed by rhinoscopy at the third postoperative month, in addition to the duration of the procedure and the postoperative complications. Results After a minimum follow-up period of 6 months, in 11 (91.7%) out of the 12 eyes with epiphora, there was complete relief of tearing. Lacrimal passages were patent to irrigation testing postoperatively. One case with late advanced atrophic rhinitis showed recurrence of tearing after silicone tube removal. No complications to the donor graft site or surgical site were observed. Conclusion Buccal mucous membrane grafting-assisted DCR (at the level of the flaps) is a safe and effective technique for the treatment of cases of refractory acquired NLD obstruction.