Comparison of Dacryoendoscopy-Aided Silicone Tube Intubation and Endoscopic Dacryocystorhinostomy for Complete Nasolacrimal Duct Obstruction

Purpose: To compare the surgical outcomes of dacryoendoscopy-aided silicone tube intubation (STI) and endoscopic dacryocystorhinostomy (endo-DCR) for complete nasolacrimal duct obstruction (NLDO), and to identify factors associated with surgical failure in dacryoendoscopy-guided recanalization. Methods: This retrospective study included patients with complete NLDO confirmed by lacrimal irrigation from January 2022 to August 2025. 26 eyes underwent dacryoendoscopic recanalization with STI, and 34 eyes underwent endo-DCR. The two groups were comparable in age, sex, preoperative Munk score, and noninvasive tear meniscus height (NITMH). Surgical success was defined as a postoperative Munk score of 0-1 at 3 months and patent irrigation. Extubation was performed at 3 months. In patients who were followed up to 6 months, the 6-month surgical success rate was also analyzed. Postoperative Munk score, NITMH, and success rate were compared. Multivariable logistic regression was performed to identify factors associated with surgical failure in the STI group. Results: 60 eyes (26 STI, 34 endo-DCR) were analyzed and no significant differences in baseline characteristics were observed between the groups. At 3 months, both groups showed significant improvement. The success rate was numerically lower in the STI group compared to the endo-DCR group (84.6% vs. 91.2%), although the difference did not reach statistical significance. At 6 months, the success rate remained numerically lower in the STI group (81.2% vs. 87.5%), but was not statistically significant. Dacryoendoscopy revealed distal nasolacrimal duct obstruction most frequently, followed by proximal duct and canaliculus, with focal and diffuse patterns equally represented. Membranous obstruction and dacryolith were observed in 19% and 7% of cases, respectively. Regularized logistic regression identified cicatricial change as the only factor significantly associated with surgical failure. Conclusions: In this small retrospective cohort, dacryoendoscopy-aided STI showed numerically similar short-term outcomes compared with endo-DCR. However, definitive conclusions regarding equivalence between the two procedures cannot be drawn from this study. Therefore, dacryoendoscopy-aided STI may be considered a potential treatment option in selected patients, particularly those who may benefit from a less invasive approach. Cicatricial change was identified as the key factor associated with reduced success following dacryoendoscopic recanalization.