Preoperative Nasoseptal-Lacrimal Fossa Distance as a Predictor of Endoscopic DCR Failure: A Retrospective Analysis

Background Dacryocystorhinostomy (DCR) is a surgery performed for nasolacrimal duct obstruction (NLDO). A high septal deflection may limit surgical access, and if not corrected, contribute to an increase in DCR failure rates due to increased adhesion formation. We hypothesize that a narrower distance between the nasal septum (NS) and lacrimal fossa (LF) is associated with higher rates of DCR failure. Objective To evaluate whether a reduced nasal septum–lacrimal fossa (NS-LF) distance is associated with higher rates of endoscopic DCR (Endo DCR) failure and to determine a clinically relevant cutoff distance that may guide consideration for concomitant septoplasty. Methods A single-institution retrospective chart review was performed for patients who received an endoscopic “Endo” DCR between July 2018 and July 2023. Data collected included demographics, septal deviation presence and laterality, NLDO laterality, and failure rates, where failure was defined as the need for a repeat ipsilateral DCR. The NS-LF distance was determined on preoperative computed tomography. Results A total of 521 patients were identified, with an average age of 60.3 years (SD = 16.47); 4.4% (n = 23) of patients experienced Endo DCR failure, requiring revision Endo DCR; 8.7% (n = 45) of patients underwent concomitant septoplasty with initial DCR. Patients who failed had a significantly shorter NS-LF distance (8.47 mm vs 9.25 mm, P = .028). Receiver operating characteristic curve analysis cutoff distance of 8.85 mm demonstrated a NS-LF distance ≥8.85 mm had a significantly lower failure rate compared to those with a distance <8.85 mm (2.6% vs 7.3%, P = .016). All revision DCRs were successful regardless of septoplasty status. Conclusion A NS-LF distance of <8.85 mm was significantly associated with Endo DCR failure, suggesting that concomitant septoplasty should be considered in these patients. Prospective studies and standardized preoperative imaging may improve surgical planning and outcomes in Endo DCR.