Document Type : Research articles


1Department of Ophthalmology, The First People's Hospital of Wenling, Wenling, Zhejiang, China


Background: Untreated chronic dacryocystitis (CD) can lead to serious ocular complications.
Objectives: This study aimed to analyze the efficacy of modified endoscopic dacryocystorhinostomy (DCR) in the treatment of CD and the effects on ocular surface, inflammatory response, and immune function of patients.
Methods: A retrospective cohort study was conducted to examine the clinical data of 110 patients (110 eyes) with CD who visited The First People's Hospital of Wenling, China, from July 2018 to February 2021, and they were divided into a conventional group (62 patients and 62 eyes underwent conventional DCR) and modified group (48 patients and 48 eyes received modified endoscopic DCR). The perioperative indexes, efficacy, and complications of the two groups were compared, and the changes in ocular surface, inflammatory response, and immune function of the patients before and 3 months after the surgery were observed.
Results: The intraoperative bleeding, hospitalization cost, and 12-h postoperative visual analogue scale (VAS) score were lower, while the operative time and hospitalization time were shorter in modified group than in the conventional group (P<0.05). The total treatment efficacy was higher (91.67%) in the modified group than in the conventional group (72.58%), and the recurrence rate was lower in the modified group (4.17%) than in the conventional group [16.13%, P<0.05]. The ocular surface symptom scores, Schirmer I test, tear break-up time, degree of tear overflow scores were lower in the modified group than in the conventional group at 3 months postoperatively (P<0.05); soluble interleukin-1?, interleukin-6, high-sensitivity C-reactive protein, CD8+ levels were lower, and CD3+, CD4+, CD4+/CD8+ levels were higher in the modified group than in the conventional group at 3 months postoperatively (P<0.05). At 3 months postoperatively, the scores of activity impairment, general health, and visual status on the National Eye Institute 25-Item Visual Function Questionnaire were higher in the modified group than those in the conventional group (P<0.05). The overall complication rate in the modified group (8.33%) was not different from that in the conventional group [14.52%, P>0.05].
Conclusion: Modified DCR has the advantages of short operation time, less trauma, less pain and fewer complications, and is conducive to improving ocular surface function, reducing inflammatory response, and improving immune function and quality of life of patients.


  1. Sagar P, Shankar R, Wadhwa V, Singh I, Khurana N. Primary tubercular dacryocystitis - a case report and review of 18 cases from the literature. Orbit. 2019;38(4):331-4. doi: 10.1080/01676830.2018.1513044. [PubMed: 30142013].
  2. Koturovic Z, Knezevic M, Rasic DM. Clinical significance of routine lacrimal sac biopsy during dacryocystorhinostomy: A comprehensive review of literature. Bosnian J Basic Med. 2017;17(1):1-8. doi: 10.17305/bjbms.2016.1424. [PubMed: 27754826].
  3. Zabolotnyi D, Minaiev O. Method of surgical treatment of chronic dacryocystitis and its effectiveness in monitoring patients in the early postoperative period. Science Rise Med Sci. 2021;1(40):21-8. doi: 10.15587/2519-4798.2021.224604.
  4. Dowling EM, Stokken JK. Outcomes of endoscopic dacryocystorhinostomy. In: Endoscopic Surgery of the Orbit. Amsterdam: Elsevier; 2021.
  5. Yim M, Wormald PJ, Doucet M, Gill A, Kingdom T, Orlandi R, et al. Adjunctive techniques to dacryocystorhinostomy: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2021;11(5):885-93. doi: 10.1002/alr.22699. [PubMed: 32981236].
  6. Anari S, Ainsworth G, Robson AK. Cost-efficiency of endoscopic and external dacryocystorhinostomy. J Laryngol Otol. 2008;122(5):476-9. doi: 10.1017/S0022215107009954. [PubMed: 17640434].
  7. Chong KK, Abdulla H, Ali MJ. An update on endoscopic mechanical and powered dacryocystorhinostomy in acute dacryocystitis
  8. and lacrimal abscess. Ann Anat. 2020;227:151408. doi: 10.1016/j.aanat.2019.07.009. [PubMed: 31465822].
  9. Zhao W. Clinical observation of high dacryocystisinostomy in the treatment of chronic dacryocystitis with lacrimal sac. Chin Arch Otolaryngol Head Neck Surg. 2022;10:669-70.
  10. Wang HX, Nie DL, Jiang M, Su WY. Clinical efficacy indexes of nasal dacryocystorhinostomy under nasal endoscope in treatment of patients with chronic dacryocystitis and clinical observation on therapeutic degree of satisfaction. Med Pharm J Chin PLA. 2021;6:88-91.
  11. Shahid E, Jafri AR, Fasih U, Shaikh A. External dacryocystorhinostomy with intubation in shrunken fibrotic sac in chronic dacryocystitis. Pak J Ophthalmol. 2020;36(2). doi: 10.36351/pjo.v36i2.1027.
  12. Li F. Chinese ophthalmology. 2nd ed. Beijing: People's Health Publishing House; 2005.
  13. Sun C. Clinical disease diagnosis based on the criteria of cure and improvement. Beijing People's Military Medical Publishing House; 2002
  14. Ozcura F, Aydin S, Helvaci MR. Ocular surface disease index for the diagnosis of dry eye syndrome. Ocul Immunol Inflamm. 2007;15(5):389-93. doi: 10.1080/09273940701486803. [PubMed: 17972223].
  15. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD, et al. Development of the 25-item national eye institute visual function questionnaire. Arch Ophthalmol. 2001;119(7):1050-8. doi: 10.1001/archopht.119.7.1050. [PubMed: 11448327].
  16. Nassiri N, Mehravaran S, Nouri-Mahdavi K, Coleman AL. National eye institute visual function questionnaire: usefulness in glaucoma. Optometry Vision Sci. 2013;90(8):745-53. doi: 10.1097/OPX.0000000000000003. [PubMed: 23851305].
  17. Kang MG, Shim WS, Shin DK, Kim JY, Lee JE, Jung HJ. A systematic review of benefit of silicone intubation in endoscopic dacryocystorhinostomy. Clin Exp Otorhinolar. 2018;11(2):81-8. doi: 10.21053/ceo.2018.00031. [PubMed: 29649861].
  18. Saniasiaya J, Abdullah B, Husain S, Wang Y, Wan MZ. Primary endoscopic endonasal dacryocystorhinostomy for pediatric nasolacrimal duct obstruction: A systematic review. Am J Rhinol Allergy. 2017;31(5):328-33. doi: 10.2500/ajra.2017.31.4464. [PubMed: 28859711].
  19. Jawaheer L, MacEwen CJ, Anijeet D. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Db Syst Rev. 2017;2(2):D7097. doi: 10.1002/14651858.CD007097.pub3. [PubMed: 28231605].
  20. Lee MJ, Kim IH, Choi YJ, Kim N, Choung HK, Khwarg SI. Relationship between lacrimal sac size and duration of tearing in nasolacrimal duct obstruction. Can J Ophthalmol. 2019;54(1):111-5. doi: 10.1016/j.jcjo.2018.03.017. [PubMed: 30851763].
  21. Sobel RK, Aakalu VK, Wladis EJ, Bilyk JR, Yen MT, Mawn LA. A Comparison of endonasal dacryocystorhinostomy and external dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2019;126(11):1580-5. doi: 10.1016/j.ophtha.2019.06.009. [PubMed: 31358391].
  22. Banks C, Scangas GA, Husain Q, Hatton MP, Fullerton Z, Metson R. The role of routine nasolacrimal sac biopsy during endoscopic dacryocystorhinostomy. Laryngoscope. 2020;130(3):584-9. doi: 10.1002/lary.28070. [PubMed: 31120602].
  23. Heichel J, Struck HG, Viestenz A, Hammer T, Viestenz A, Fiorentzis M. Anatomic landmarks in lacrimal surgery from an ophthalmologist's point of view: Clinical findings of external dacryocystorhinostomy and dacryoendoscopy. Clin Anat. 2017;30(8):1034-42. doi: 10.1002/ca.22902. [PubMed: 28509331].
  24. Yang X, Wang L, Li L, Yu Z, Xiao C. the imbalance of lymphocyte subsets and cytokines: potential immunologic insights into the pathogenesis of chronic dacryocystitis. Invest Ophth Vis Sci. 2018;59(5):1802-9. doi: 10.1167/iovs.17-23660. [PubMed: 29610847].
  25. Ali MJ, Mulay K, Pujari A, Naik MN. Derangements of lacrimal drainage-associated lymphoid tissue (LDALT) in human chronic dacryocystitis. Ocul Immunol Inflamm. 2013;21(6):417-23. doi: 10.3109/09273948.2013.797473. [PubMed: 23924208].