title: Unsuccessful lacrimal surgery: causative factors and results of surgical management in a tertiary referral center.
abstract: BACKGROUND
  To evaluate possible causative factors of unsuccessful dacryocystorhinostomy (DCR) surgery, and present the surgical technique and results of revision external DCR in a tertiary referral center.
  
  
  METHODS
  During 2001-2007, 79 patients (59 female, 20 male, 83 revised DCR sites) underwent revision external DCR for the management of recurrent epiphora after unsuccessful DCR surgery. The possible reasons for unsuccessful DCR surgery were noted according to the preoperative nasal endoscopic and perioperative findings, and revision surgery was performed to address these.
  
  
  RESULTS
  The mean age was 43.1 ± 12.0 years, and the mean follow-up was 21.4 ± 12.4 months. At presentation, 58 patients had a history of 1 unsuccessful lacrimal surgery, 16 had 2 unsuccessful surgeries, and 5 had 3 unsuccessful surgeries. The most common preoperative endoscopic finding was nasal mucosal fibrosis and synechiae, and the most common causes of unsuccessful DCR surgery were inappropriate size and location of the bony ostium, fibrosis at rhinostomy site, and canalicular obstruction, respectively. Of the 83 revised DCR sites, 79 sites underwent external DCR with silicone intubation, and conjunctival DCR with Jones tube insertion was performed in 4 sites. Success was achieved in 78 sites (93.9%) with the first revision DCR surgery, and in 81 sites (97.6%) with the second revision.
  
  
  CONCLUSIONS
  Revision DCR has standard concepts in common with primary DCR surgery; however, for a favorable surgical outcome, the revision surgery should address possible causative factors of failure.
authors.affiliation: Department of Ophthalmology, Gazi University School of Medicine, Ankara, Turkey. okonuk@gazi.edu.tr
authors.forename: Onur
authors.initials: O
authors.lastname: Konuk
authors.forename: Mine
authors.initials: M
authors.lastname: Kurtulmusoglu
authors.forename: Zaure
authors.initials: Z
authors.lastname: Knatova
authors.forename: Mehmet
authors.initials: M
authors.lastname: Unal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000601:surgery; D003608:Dacryocystorhinostomy / Q000009:adverse effects*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007440:Intubation; D007766:Lacrimal Apparatus Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007767:Lacrimal Duct Obstruction / Q000473:pathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D012017:Referral and Consultation; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012828:Silicones; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D012828:Silicones