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Comparison of patient satisfaction after endoscopic endonasal versus external dacryocystorhinostomy: a quality of life assessment
WK Wong*, S Han*, S Dean**, S Nair*
* Department of Otolaryngology, Head and Neck Surgery, Counties Manukau DHB, Auckland
**Department of Ophthalmology, Counties Manukau DHB, Auckland
Introduction:
Epiphora has a significant impact on patient’s quality of life. It causes blurred vision, eyelid irritation and social embarrassment. A common cause is nasolacrimal duct obstruction. Dacryocystorhinostomy (DCR) has traditionally been performed by Ophthalmologists via an external approach, involving a skin incision. The procedure serves to directly connect the lacrimal sac to the nasal cavity in order to bypass the site of obstruction. With the advent of endoscopes, the endonasal approach to DCR has gained immense popularity. Numerous studies in the past decade have shown that the success rates of both approaches are equal.1
Aims:
To prospectively assess the subjective perception of quality of life of adult patients who underwent either endonasal DCR or external DCR for acquired nasolacromal duct obstruction.
Methods:
Lac-Q questionnaire was administered pre- and postoperatively in all patients. Lac-Q is a validated symptom-based questionnaire specifically designed to assess the subjective perception of one’s well-being from an ocular symptomatology standpoint. The two domains evaluated are eye-specific symptoms and the social impact of the condition. The total scores range from 0 (no complaints) to 33 (maximal degree of ocular symptoms and social impact).
Results:
Sixty-two patients (24 endonasal, 38 external) were recruited. All patients had a preoperative assessment. The overwhelming majority of patients had a postoperative assessment at 3 months and 1 year. Patients in the external DCR group reported a mean improvement of +7.54 in total Lac-Q score following their operation (5.18-9.90). In contrast, the mean improvement in postoperative Lac-Q score in the endonasal, endoscopic DCR group was +10.32 (7.8-12.83), p=0.096.
Conclusion:
Our study showed that both endoscopic endonasal and external DCR can lead to reduction of symptoms and improvement in quality of life using a validated questionnaire.
References:
1. Feretis M, Newton JR. Comparison of external and endonasal dacryocystorhinostomy. JLO (2009) 123:315–319.
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