Long-Term Outcomes of External Dacryocystorhinostomy with U-Flap and Nasolacrimal Intubation in Adult Patients with Small Lacrimal Sac and Primary Nasolacrimal Duct Obstruction

Czech version

Authors: Anupam Singh ¹; Anue Choudhary ¹; Shreya Mishra ¹; Anam Ansari ¹; Bala Kiran Mallik ¹; Barun Kumar ²
Authors‘ workplace: Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, India ¹; Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, India ²
Published in: Čes. a slov. Oftal., 82, 2026, No. 3, p. 161-165
Category: Original Article
doi: https://doi.org/10.31348/2025/42

Overview

Aim: To report long-term postoperative outcomes of external dacryocystorhinostomy (Ext-DCR) with U-flap and nasolacrimal intubation in adult patients with small lacrimal sac and primary nasolacrimal duct obstruction (NLDO).

Material and methods: This case series was conducted in a tertiary health care center of North India and included 26 patients who underwent Ext-DCR with U-flap with nasolacrimal intubation for primary NLDO and small lacrimal sac from June 2021 to January 2024 with a minimum follow-up period of 12 months.

Results: Out of 26 patients, 22 were females with a mean age of 50 years (range 21–60). All patients had a history of purulent discharge from the affected eye. Excessive bleeding was the most common intraoperative challenge faced in most of the cases (6, 23%). The intubation set was removed 12 weeks after surgery. Two female patients had tube-related complications in the form of granuloma formation, and two patients had tube retraction, one had slitting of the punctum, and another acquired an infection. The remaining 20 patients had an uneventful postoperative period. The outcomes of only 2 patients were reported as failures (8%), and the remaining 24 reported successful outcomes (92%) after 12 months of follow-up.

Conclusion: Ext-DCR with U-flap and nasolacrimal intubation is an effective procedure with a high long-term success rate in adult patients with a small lacrimal sac and primary NLDO.

Keywords:

external DCR – U-flap – nasolacrimal intubation – chronic dacryocystitis – small lacrimal sac

Sources

1. Jawaheer L, MacEwen CJ, Anijeet D. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017;2017(2). Art. No.: CD007097.

2. Bukhari AA. Meta-analysis of the effect of posterior mucosal flap anastomosis in primary external dacryocystorhinostomy. Clin Ophthalmol. 2013;7 : 2281-2285.

3. Sharma HR, Sharma AK, Sharma R. Modified external dacryocystorhinostomy in primary acquired nasolacrimal duct obstruction. J Clin Diagn Res. 2015;9(10):NC01–05.

4. Kacaniku G, Begolli I. External dacryocystorhinostomy with and without suturing the posterior mucosal flaps. Med Arch. 2014;68(1):54-56.

5. Lee MJ, Khwarg SI, Kim IH, et al. Surgical outcomes of external dacryocystorhinostomy and risk factors for functional failure: a 10 -⁠ year experience. Eye (Lond). 2017;31(5):691-697.

6. Mannor GE, Millman AL. The prognostic value of preoperative dacryocystography in endoscopic intranasal dacryocystorhinostomy. Am J Ophthalmol. 1992;113(2):134-137.

7. Hammoudi DS, Tucker NA. Factors associated with outcome of endonasal dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2011;27(4): 266-269.

8. Ariturk N, Oge I, Oge F, Erkan D, Havuz E. Silicone intubation for obstruction of the nasolacrimal duct in adults. Acta Ophthalmol Scand. 1999;77 : 481-482.

9. Hurwitz JJ. Disease of the sac and duct. In: Hurwitz JJ. The Lacrimal System. Philadelphia: Lippincott-Raven Publisher, 1996, Chapter 22, p. 136.

10. Kashkouli MB, Beigi B, Murthy R, Astbury N. Acquired external punctal stenosis: etiology and associated findings. Am J Ophthalmol. 2003 Dec;136(6):1079-1084.

11. Toti A. Nuovo metodo conservatoire di cura radicale delle suppurazioni croniche del sacco lacrimale (dacriocistorinostomia). Clin Mod Pisa. 1904;10 : 385-387. Italian.

12. Woog J. J., Kennedy R. H., Custer P. L., Sara A. K., Dale R. M., Jorge G. C. Endonasal dacryocystorhinostomy: a report by the American academy of ophthalmology. Ophthalmology. 2001;108(12):2369 -⁠ 2377.

13. Caesar RH, Fernando G, Scott K, McNab AA. Scarring in external dacryocystorhinostomy: fact or fiction? Orbit. 2005;24(2):83-86.

14. Baldeschi L, Nardi M, Hintschich CR, Koornneef L. Anterior suspended flaps: a modified approach for external dacryocystorhinostomy. Br J Ophthalmol. 1998;82 : 790-792.

15. Elwan S. A randomized study comparing DCR with and without excision of the posterior mucosal flap. Orbit. 2003;22 : 7-13.

16. Serin D, Alagoz G, Karsloglu S, Celebi S, Kukner S. External Dacryocystorhinostomy: Double-Flap Anastomosis or Excision of the Posterior Flaps? Ophthalmic Plast Reconstr Surg. 2007;23 : 28 -⁠ 31.

17. Kim NJ, Kim JH, Hwang SW, Choung HK, Lee YJ, Khwarg SI. Lacrimal silicone intubation for anatomically successful but functionally failed external dacryocystorhinostomy. Korean J Ophthalmol. 2007;21(2):70-73.