Clinical Factors Affecting the Surgical Outcomes of Endoscopic Dacryocystorhinostomy

Objectives: Factors influencing outcomes of endoscopic dacryocystorhinostomy (DCR) for primary acquired nasolacrimal duct obstruction remain unclear. We evaluated clinical factors associated with surgical success. Methods: We retrospectively reviewed patients who underwent endoscopic DCR for this indication (2012–2022). Allergic rhinitis, obstruction level and type, canalicular intubation stent (CIS) insertion, and adjunctive procedures were analyzed against surgical success, epiphora scores, and SNOT-22 change using multivariate logistic regression. Results: Among 300 eyes (259 patients), the success rate was 82.0%. Epiphora scores improved from 7.6 ± 1.3 to 4.0 ± 2.3 and SNOT-22 from 17.3 ± 19.1 to 11.1 ± 14.2 (both p < 0.001). Sac-level and duct–sac junction obstructions had higher success than canalicular obstruction, and allergic rhinitis was associated with less epiphora improvement. CIS insertion was associated with lower success; however, this was confined to functional (42.0% vs. 92.0%) and canalicular-level (53.3% vs. 77.6%) obstruction—where CIS was selectively used—and absent in drainage-level obstruction (85.3% vs. 85.7%), indicating confounding by indication. Conclusions: Endoscopic DCR yields favorable outcomes with significant epiphora and quality-of-life improvement. Obstruction level, allergic rhinitis, and CIS insertion were associated with surgical outcomes; the CIS association, however, likely reflects confounding by indication rather than a direct adverse effect, as CIS was selectively used in functional and canalicular-level obstruction.