Endonasal dacryocystorhinostomy in a district general hospital: High functional success with low revision rates

Background: Dacryocystorhinostomy (DCR) is the definitive treatment for nasolacrimal duct obstruction. Endonasal techniques are increasingly used, with published literature reporting high success rates.

Purpose: To evaluate functional outcomes following endonasal DCR in a district general hospital and compare results with published data and previous audit cycles.

Methods: A retrospective cohort study was conducted of all patients undergoing DCR from January 2021 to January 2025. Patients were identified from theatre records, with clinical data obtained from electronic health records. Variables collected included demographics, level of obstruction, symptom-based functional outcome scores (DAB), functional success, and revision rates. Outcomes were compared with published literature and previous departmental audit data.

Results: Twenty–four patients (30 eyes) underwent DCR, with a mean age of 70.1 years. The majority of cases involved nasolacrimal duct obstruction (96.7%). All procedures were performed via an endonasal approach.

Mean symptom-based functional scores (DAB) improved from 37 pre-operatively to 19 post-operatively, reflecting a reduction in symptom burden. Functional success was achieved in 93.3% of cases, with a low revision rate of 3.3% (1/30). A reduction in revision procedures was observed compared to previous audit cycles within the unit, with 1 revision in the current cohort compared to 8 between 2017–2021 and 18 prior to 2017. The observed functional success rate of 93.3% lies at the upper end of reported success rates for endonasal DCR (71-94%) demonstrating outcomes consistent with published data and supporting the effectiveness of an endonasal-first approach in routine clinical practice.

Conclusion: In this cohort, endonasal DCR achieved high functional success with low revision rates in a district general hospital setting. Outcomes were consistent with published data and demonstrate a reduction in revision procedures compared to previous audit cycles, supporting the continued use of an endonasal-first approach in routine clinical practice. Ongoing outcome monitoring remains important to optimise patient outcomes.