title: External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost.
abstract: BACKGROUND
  External dacryocystorhinostomy (DCR) is the standard treatment for nasolacrimal duct obstruction, with success rates consistently above 90%. This study reviews the demographics, success, cost, efficiency, and patient satisfaction in external DCR. This information will be useful as comparison criteria for evaluating new surgical techniques.
  
  
  METHODS
  Records of 169 external DCR procedures performed over an 8.7-year period were reviewed. All patients had preoperative symptoms of tearing and/or dacryocystitis with a component of nasolacrimal obstruction. Patient demographics, history, examination findings, surgical and anesthesia information, postoperative success, complications, and follow-up course were recorded. Patient satisfaction and long-term success were evaluated by telephone survey.
  
  
  RESULTS
  External DCR often required middle turbinectomy (17%), exposure of ethmoid sinuses (17%), and removal of dacryoliths (14%). Most patients (90%) underwent silicone intubation, with the tubes removed at an average of 3.7 weeks after surgery. A patent system was established in 95% of procedures, whereas 92% remained asymptomatic. Postoperative complications included hemorrhage (3.9%) and scarring (2.6%). Of the surveyed patients, 87% denied continued or recurrent symptoms; 97% rated their incision "good" to "excellent" in appearance; and all patients stated they would recommend the procedure to others.
  
  
  CONCLUSIONS
  External DCR is highly successful, requires limited follow-up, and is a cost-effective procedure. Complications are uncommon, and patient satisfaction is high. New lacrimal surgical techniques must be evaluated against the long-proven success of the external approach.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Tarbet
authors.forename: P L
authors.initials: PL
authors.lastname: Custer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003608:Dacryocystorhinostomy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome