Endoscopic Dacryocystorhinostomy May Exacerbate Dry Eye Symptoms

Patients with dry eye who undergo endoscopic dacryocystorhinostomy for primary acquired nasolacrimal duct obstruction (PANDO) may experience worse dry eye symptoms following surgery, according to research published in the Korean Journal of Ophthalmology. The short onset of tearing is associated with the development of dry eye, according to the report. 

Researchers retrospectively analyzed the medical records of 80 patients (mean age, 60.2 years; age range, 34-84 years; 56 women, 24 men) with PANDO combined with dry eye disease who underwent endoscopic dacryocystorhinostomy between March 2013 and April 2016. They divided participants into 2 groups according to the questionnaire about dry eye symptoms following surgery. 

Before and after surgery, the research team compared the tear meniscus height (TMH), tear break-up time (TBUT), and the presence of corneal punctuate epithelial erosion (PEE). They assessed the level of dry eyes of patients after surgery by utilizing the Korean guidelines for the diagnosis of dry eye.

The researchers report that the proportions of patients who complained of postoperative dry eye symptoms were 11.3%, 8.8%, and 30.0% at 1, 2, and 6 months, respectively. 

The duration of epiphora and TBUT after endoscopic dacryocystorhinostomy were higher in the group without dry eye symptoms, while the proportion of eyes with corneal PEE after endoscopic dacryocystorhinostomy was higher in the group with dry eye symptoms, the report shows. 

Approximately 15% of all patients who underwent endoscopic dacryocystorhinostomy started treatment with a dry eye of level II or higher.

“Moderate to severe dry eye might be more related to severe inflammation; It is possible that a relatively short-term but severe inflammatory response may cause lacrimal drainage pathway obstruction or worsen compared with patients without dry eyes before EDCR,” the researchers report. “On the other hand, in patients without significant dry eye before EDCR, lacrimal drainage pathway obstruction can develop slowly due to unknown causes over a long period of time. Most symptoms and signs of dry eye must be masked by PANDO.”

Study limitations include its retrospective design, small sample size, and follow-up periods were short.