Orbital lobe dacryoadenectomy for refractory epiphora: a retrospective case series

PURPOSE: To evaluate epiphora and ocular surface outcomes after macroscopically complete orbital lobe dacryoadenectomy with palpebral lobe preservation in selected patients with refractory epiphora after failed or intolerable conjunctivodacryocystorhinostomy (CDCR). METHODS: This retrospective single-center case series included 11 consecutive patients with proximal canalicular obstruction and persistent epiphora after Jones tube failure or intolerance. The primary outcome was change in Munk score at 6 months. Secondary outcomes included Schirmer I, tear film break-up time (TBUT), lower tear-meniscus height, ocular surface findings, satisfaction, reintervention and complications. Eight patients (72.7%) were satisfied or very satisfied and 10 (90.9%) were at least moderately satisfied. No patient underwent further lacrimal intervention or met the defined documentation based ocular surface event. CONCLUSIONS: In this highly selected series, macroscopically complete orbital lobe dacryoadenectomy with palpebral lobe preservation was associated with substantial improvement in refractory epiphora after failed or intolerable CDCR. Reduced Schirmer I and TBUT support cautious patient selection and longer prospective follow-up.