Anatomischer und subjektiver Erfolg einer strukturierten chirurgischen Therapiestrategie zum Management der chronischen Epiphora eine postoperative Zufriedenheitsanalyse

Background: Epiphora is the result of hypersecretion or reduced tear outflow because of relative or absolute obstruction of the lacrimal system. For the treatment a specific surgical procedure is usually required. Herein we present the subjective and objective findings of 243 consecutive patients with non-irritative induced epiphora, who underwent an operation in a standardised therapy scheme, which is used at the eye departments of the Universities of Lübeck and Würzburg. Patients and Methods: In a retrospective cohort study 243 patients were included who underwent lateral tarsal strip (n = 72), external dacryocystorhinostomy (DCR) in the case of an absolute nasolacrimal duct obstruction (NLDO) (n = 116) and relative NLDO (n = 25), DCR with canalicular surgery (n = 18) and simple canalicular surgery (n = 12) with a follow-up of at least 6 month. Common patient and cosmetical satisfaction, intensity of symptoms and further symptoms of 168 patients were evaluated by sending a questionnaire with subsequent telephone survey. Objective findings were recorded from hospital charts. Results: 59.5 % of the patients were free of complaints, 19.6 % had an absolute decrease of symptoms (epiphora outside and in windy weather) and 20.8 % persistent epiphora (symptoms both in- and outside persisted). 81 % of patients with absolute NLDO and 57 % with relative NLDO were graded as being free of symptoms, 7 % (24 %) as a relative decrease and 12 % (19 %) as a persistence of symptoms. There was a significant difference in success between these indications (p = 0.018). Patency of the lacrimal system assessed by irrigation was found in 95 % (absolute NLDO). Commonly, 73.8 % were satisfied, 7.7 % indifferent and 18.4 % not satisfied. 4 patients were cosmetically not satisfied. Conclusions: Use of a standardised therapy scheme reduces the symptoms in 79.1 % of the patients. In patients with absolute NLDO external DCR achieves an anatomic success rate of 95 % and a subjective improvement in 88 % with excellent cosmetic results. In comparison with absolute NLDO the success rate of relative NLDO is lower, but still with a subjective improvement in 81 %. Our results show that postoperative success depends on the preoperative cause of the epiphora.