Endonasal dacryocystorhinostomy: a comparative study of two lacrimal sac approaches

Abstract

Purpose: To compare surgical outcomes of 2 lacrimal sac approaches (medial wall excision and marsupialization) in endonasal dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO). Methods: This retrospective study included 78 eyes of 73 patients who underwent endoscopic DCR between June 2017 and January 2024. Group 1 underwent medial wall excision; Group 2 had marsupialization. All surgeries were performed by a single surgeon. Demographic data, preoperative Munk score, symptom duration, operative time, complications, and success rates were evaluated. Functional success was defined as the complete resolution of epiphora as reported by the patient; anatomical success as a patent ostium regardless of symptoms. Results: Group 1 included 41 eyes (52.6%), and Group 2, 37 eyes (47.4%). Mean operative time was shorter in Group 1 (38.17 ± 8.60 min) than Group 2 (44.97 ± 11.70 min; p = 0.004). Functional and anatomical success rates were 87.2% and 89.7%, with no significant difference (p = 0.999). Minor complications occurred in both groups and resolved conservatively. Conclusion: Both techniques offer similarly high success in endonasal DCR. Medial wall excision may provide technical ease with shorter operative time.