Factors affecting etiology and En-DCR outcomes in nasolacrimal duct obstruction: a retrospective cohort study.

Objective: This study aimed to characterize the statistical profiles of potential pathogenic factors and identify determinants influencing the success of endoscopic dacryocystorhinostomy (En-DCR) through comprehensive analysis of clinical data from patients with nasolacrimal duct obstruction (NLDO).

Methods: We reviewed 1008 patients (1140 eyes) with nasolacrimal duct obstruction (NLDO) who underwent endoscopic dacryocystorhinostomy (En-DCR) between September 2020 and June 2023. Data on demographics, clinical features, previous diagnosis and treatment, preoperative interventions, and the results of NLDO-related examinations were recorded. Postoperative outcomes were assessed by reviewing clinic visit records and telephone follow-up conducted during routine care, with success defined as complete resolution of epiphora and patent irrigation. Multivariable logistic regression was used to identify independent risk factors associated with surgical outcome.

Results: Among 1008 patients (1140 eyes), 35.9% had snoring/sleep apnea, 20.9% gastroesophageal reflux disease (GERD), and 19.3% a family history of epiphora. Of 851 females, 80.5% were menopausal, with 26.8% having gynecologic disease history and 11.5% prior gynecologic surgery. En-DCR achieved a 95.6% success rate. Multivariable analysis identified regurgitation on pressure over the lacrimal sac (ROPLAS) sign (OR = 0.25, 95% CI 0.13-0.48, p < 0.001) and minimum lacrimal sac diameter on dacryocystography (OR = 8.71, 95% CI 2.57-29.57, p < 0.001) as independent predictors of outcome.

Conclusion: NLDO frequently coexists with comorbidities including paranasal sinusitis/nasal polyps, chronic conjunctivitis, dry eye, GERD, family history of epistaxis, and sleep-disordered breathing (sleep apnea/snoring). Notably, ROPLAS sign and minimum lacrimal sac diameter ≤ 3 mm on dacryocystography independently predict En-DCR outcomes, with the latter demonstrating a particularly strong association (OR = 8.71, p < 0.001). These findings highlight the importance of preoperative assessment of lacrimal sac anatomy and clinical signs in optimizing surgical success.