Background: The purpose of this study was to evaluate the causes of failure of external dacryocystorhinostomy in a tertiary care hospital.

Methods:  53 patients of failed DCR of either gender were subjected to complete ophthalmic and lacrimal system examination besides doing CT-DCG. The radiologist blinded to the clinical profile of the patient evaluated size of bony ostium, soft tissue cicatrization, bony regrowth, secondary stenosis of canaliculi, synechiae between the ostium and nasal septum and anatomic variations in nasal cavity, turbinates or nasal septum.

Results: The most common causes of failure in our study were inappropriate size of osteotomy window in 43 patients (78.3), fibrous tissue scarring at osteotomy window in 28 patients (54.4), the other causes were bilateral concha bullosa in 2 patients, common canalicular block in 3 patient, faulty passage into ethmoidal sinus in one patient and one patient had no bone window. .

Conclusions: CT-DCG is a valuable imaging tool to evaluate DCR failure and planning revision sugery. In our study CT-DCG showed that small size of osteotomy window, fibrous tissue scarring at osteotomy window were frequently seen causative factors of DCR failure.

Keywords: Computed tomographic dacryocystography, Computed tomography, Dacryocystorhinostomy  

1. Tarbet KJ, Custer PL. External dacryocystorhinostomy. Surgical success, patient satisfaction and economic costs. Ophthalmology. 1995;102:1065–70. [PubMed] [Google Scholar]
2. 2 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. Ophthalmol. 2005;112(8):1463-8.
3. Kim NJ, Kim JH, Hwang SW, Choung HK, Lee YJ, Khwarg SI. Lacrimal silicone intubation for anatomically successful but functionally failed external dacryocysto-rhinostomy. Kore J Ophthalmol. 2007;21(2):70-3.
4. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction: A clinico-pathological report. Ophthalmo-logy. 1986;93:1055–62. [PubMed] [Google Scholar]
5. Bartley GB. Acquired lacrimal drainage obstructions: An etiologic classification system, case reports and review of literature. Ophthal Plast Reconstr Surg. 1992;8:237–49. [PubMed] [Google Scholar]
6. Saha R, Sinha A, Phukan JP. Endoscopic versus external approach dacryocystorh-inostomy: A comparative analysis. Niger Med J. 2013;54(3):165–9. [PMC free article] [PubMed] [Google Scholar]
7. El-Guindy A, Dorgham A, Ghoraba M. Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol. 2000;109(4):425–30. [PubMed] [Google Scholar]
8. Savino G, Battendieri R, Traina S, Corbo G, D'Amico G, Gari M, et al. External vs. endonasal dacryocystorhinostomy: has the current view changed? Acta Otorhino-laryngol Ital. 2014;34(1):29–35 [PMC free article] [PubMed] [Google Scholar]
9. Ali MJ, Naik MN, Honavar SG. External dacryocystorhinostomy: Tips and tricks. Oman J Ophthalmol. 2012;5(3):191–5. [PMC free article] [PubMed] [Google Scholar]
10. Duggal P, Chakravorty S, Azad RK, Mohan C. An epidemiological study on patients undergoing dacryocystorhin-ostomy. Indian J Otolaryngol Head Neck Surg. 2006;58(4):349–51. [PMC free article][PubMed] [Google Scholar]
11. Thornton SP. Nasolacrimal duct reconstruction with the nasolacrimal duct prosthesis: an alternative to standard dacryocystorhinostomy. Ann Ophthalmol. 1977;9(12):1575–8. [PubMed] [Google Scholar]
12. 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. [PubMed] [Google Scholar]
13. Choussy O, Retout A, Marie JP, Cozlean A, Dehesdin D. Endoscopic revision of external dacryocystorhinostomy failure. Rhinology. 2010;48(1):104–7. [PubMed] [Google Scholar]
14. Elmorsy SM, Fayk HM. Nasal endoscopic assessment of failure after external dacryocystorhinostomy.Orbit. 2010;29(4):197–201. [PubMed] [Google Scholar]
15. Korkut AY, Teker AM, Ozsutcu M, Askiner O, Gedikli O. A comparison of endonasal with external dacryocystorh-inostomy in revision cases. Eur Arch Otorhinolaryngol. 2011; 268(3):377–81. [PubMed] [Google Scholar]
16. Liang J, Hur K, Merbs SL, Lane AP. Surgical and anatomic considerations in endoscopic revision of failed external dacryocystorhinostomy. Otolaryngol Head Neck Surg. 2014;150(5):901–5. [PubMed] [Google Scholar]
17. Glatt HJ, Chan AC, Barrett L. Evaluation of dacryocystorhinostomy failure with computed tomography and computed tomographic dacryocystography. Ame J Ophthalmol. 1991;112(4):431-6
18. Gokcek A, Argin MA, Altintas AK. Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings. Euro J Ophthalmol. 2005;15(5):523-9.
19. Jordan DR, McDonald H. Failed dacryocystorhinostomy: the sump syndrome. Ophthal Surg. 1993;24(10): 692-3.
20. Welham RA, Wulc AE. Management of unsuccessful lacrimal surgery. Brit J Ophthalmol. 1987;71(2):152-7.
21. McLachlan DL, Shannon GM, Flanagan JC. Results of dacryocystorhinostomy: analysis of the reoperations. Ophthalmic surg. 1980;11(7):427-30.
22. Dave TV, Mohammed FA, Ali MJ, Naik MN. Etiologic analysis of 100 anatomically failed dacryocystorhin-ostomies. Clinic Ophthalmol (Auckland, NZ). 2016;10:1419.
23. Linberg JV, Anderson RL, Bumsted RM, Barreras R. Study of intranasal ostium external dacryocystorhinostomy. Archives Ophthalmol. 1982;100(11):1758-62.
24. Yazici B, Yazici Z. Final nasolacrimal ostium after external dacryocystorhi-nostomy. Archives Ophthalmol. 2003;121(1):76-80.
25. Vivekanand U, Gonsalves S. Etiologies of Failed External Dacryocystorhinostomy-A Case Series. Indidan journal of applied research. 2014;4(3).
26. Yarmohammadi ME, Ghasemi H, Jafari F, Izadi P, Nadoushan MJ, Chin NS. Teamwork endoscopic endonasal surgery in failed external dacryocystorhinostomy. J ophthal vision Res. 2016;11(3):282.
27. Kushwaha RN, Rastogi R, Gupta RC, Gupta P, Kumar S. Profile of ocular trauma in tertiary care centre. Journal of Evolution of Medical and Dental Sciences. 2013;2(27):4903-15.
28. Pradham B. Outcome of Endoscopic DCR at TUTH. Nepalese J ENT Head Neck Surg. 2012;2(1):20-1.
29. Waite DW, Whitted HB, Shun-Shin GA. Technical note: computed tomographic dacryocystography. Br J Radiol. 1993;6:711-4.
30. Mauriello Jr JA, Vahedra V, Fleckner M, Shah C. Correlation of orbital computed tomographic findings with office probing and irrigation in 17 patients after successful and failed dacryocysto-rhinostomy. Ophthalmic Plastic Reconstructive Surg. 1999;15(2):116-20.
31. Manfrè L, de Maria M, Todaro E, Mangiameli A, Ponte F, Lagalla R. MR dacryocystography: comparison with dacryocystography and CT dacryocystography. Ame J Neuroradiol. 2000;21(6):1145-50.
32. Helies P, Cosnard G, Pharaboz C, Maille M, Maurin JF. Dacryocystography using CT and MRI. Comparative study apropos of 13 clinical cases. J Fr Ophtalmol. 1995;18:763-70.
33. Eldesoky S, Farouk H, Moustafa AN, El-noueam K, Elsabaa A. The role of multi-detector CT dacryocystography in the assessment of naso-lacrimal duct obstruction. Egy J Radiol Nuclear Medic. 2012;43(3):397-405.
34. Udhay P, Noronha OV, Mohan RE. Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses. Ind J Ophthalmol. 2008;56(1):31.

Dr Aamina Shah