Predictors of Success and Long-Term Outcome in Endoscopic Dacryocystorhinostomy: Single-Center Study

Background Endoscopic dacryocystorhinostomy (eDCR) is the preferred surgical treatment for nasolacrimal duct obstruction. However, long-term outcome data and reliable predictors of surgical success remain limited. Objective To assess long-term functional outcomes of eDCR and identify factors associated with recurrence in a large single-center cohort with long-term follow-up. Methods We conducted a retrospective cohort study including all patients who underwent primary endonasal eDCR between 1998 and 2022 at a tertiary referral center. Primary outcomes were functional success (absence of epiphora) after first and, if necessary, second surgery, and time to recurrence following primary eDCR. Recurrence-free survival was analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Secondary outcomes included concordance among preoperative diagnostic tests and perioperative complications. Results A total of 280 patients underwent 313 primary unilateral eDCR procedures. Functional success after first surgery was achieved in 86.9% of cases, with 41 recurrences (13.1%). After secondary procedures, 95.2% of operated sides were symptom-free. Estimated recurrence-free survival was 93.5% at 1 year, 90.8% at 3 years, and 88.5% at 5 years. On multivariable analysis, concomitant unciformectomy was independently associated with a reduced risk of recurrence (hazard ratio 0.27; 95% CI, 0.13-0.56; P < .001). Agreement among preoperative diagnostic tests was limited, with only fair concordance between fluorescein testing or dacryography and dacryo-CT-scan imaging (Cohen's κ 0.25-0.29). No major surgical complications were observed. Conclusion eDCR provides durable long-term relief of epiphora with high functional success rates. Concomitant unciformectomy appears to reduce the risk of recurrence significantly and may represent an important surgical step in optimizing long-term outcomes. Limited concordance among preoperative diagnostic tests supports the use of a complementary diagnostic approach in clinical practice.