Postoperative Outcomes of Bi-Canalicular Silicone Stenting in Endoscopic Dacryocystorhinostomy: A Prospective Comparative Study

Abstract

Background: Chronic dacryocystitis due to nasolacrimal duct obstruction (NLDO) causes persistent epiphora. Endoscopic dacryocystorhinostomy (En-DCR) creates an alternate tear drainage pathway with success rates nearing those of external DCR[1]. Surgeons often use bi-canalicular silicone stents to maintain ostium patency, but their benefit is controversial. Some studies suggest a slight improvement in success with stents[2][3], whereas others report no clear advantage and possible stent-related complications (granulation tissue, punctal erosion)[4]. This study compares postoperative outcomes of En-DCR with versus without bi-canalicular silicone intubation.

Materials and Methods: We conducted a prospective, randomized study of 60 adult patients (14–70 years) with primary NLDO causing chronic dacryocystitis. Patients were randomly assigned to Group A (En-DCR with bicanalicular silicone stent, n=30) or Group B (En-DCR without stent, n=30). Preoperatively, all patients underwent lacrimal syringing and endoscopic nasal evaluation to confirm saccal or post-saccal obstruction. Surgeries were standardized (endonasal sac osteotomy with mucosal marsupialization) and performed under general anesthesia. In Group A, a silicone stent was placed through both canaliculi and left in situ for 6 weeks; Group B had no intubation. Postoperative care was identical. Functional patency (syringing test) and symptomatic success (Munk’s epiphora score) were assessed at 1 week, 3 weeks, 3 months, and 6 months. Outcomes were analyzed objectively (patent vs. blocked) and subjectively (Munk score 0 = complete relief). Statistical comparisons (Chi-square or Fisher’s exact test) evaluated differences in success rates.

Results: The mean patient age was ~50.5 years (range 14–70), with no significant difference between groups (mean 50.3 vs 50.7 years, P=1.0). Female predominance was noted (77% overall). Baseline characteristics – including age, sex, and laterality – were similar between groups (Table 1). Chronic inflammation was idiopathic in 75% and recurrent in 25% of cases; Group A had a higher proportion of inflammatory cases (40% vs 10%), but this did not affect overall results. At 6 months, anatomical success (ostium patency on syringing) was achieved in 28/30 (93.3%) patients in Group A and 26/30 (86.7%) in Group B (Figure 1). Symptomatic success (Munk score 0) was identical: 28/30 (93.3%) in Group A vs 26/30 (86.7%) in Group B (Figure 2). The difference in success rates was not statistically significant (Group A vs B, P=0.67). Early postoperative patency at 3 weeks was similarly high (100% vs 96.7%). By 6 months, two failures in Group A and four in Group B were noted; the intergroup difference remained nonsignificant. Postoperative complications are summarized in Table 2. Minor rhinostomal granulations and synechiae occurred infrequently in both groups. Group A (stented) had 2 cases of tube extrusion (6.7%), which required early removal; Group B had 2 cases of granulation (6.7%) and 1 minor nasal bleed. No patient had canalicular injury or punctal erosion. Overall, 20% of stented eyes and 23% of non-stented eyes experienced any complication (no significant difference).

Conclusion: In this series, endoscopic DCR with bi-canalicular silicone intubation produced high success (93%) comparable to non-intubated DCR (87%), consistent with prior analyses[2][3]. The small, non-significant trend favoring stents matches meta-analyses showing only a modest benefit of silicone tubes in primary En-DCR[2][3]. However, stent-related issues (tube extrusion) and additional cost must be weighed. Given similar outcomes and some stent morbidity, routine intubation for uncomplicated primary En-DCR may be unnecessary[4][5]. We recommend reserving stents for selected cases (e.g. canalicular stenosis, revision DCR) as suggested in the literature[4][6]. These findings add to the evidence base guiding DCR technique in modern practice.