title: The cosmetic outcome of external dacryocystorhinostomy scar and factors affecting it.
abstract: OBJECTIVE
  To study the cosmetic outcome of external dacryocystorhinostomy (Ex-DCR) and to detect the factors affecting it.
  
  
  METHODS
  Prospective randomized interventional study included forty patients who were treated by 40 Ex-DCRs. In twenty patients, medial canthal vertical incision was used and in the other twenty cases, subciliary incision was used. The skin was closed using vicryl 6-0 or prolene 6-0 interrupted sutures, and each one was randomly used in twenty patients (10 patients of each incision type). Cosmetic outcome was evaluated 6 months postoperative by the patients and by an oculoplastic surgeon on a four grades scale. Cosmetic results and its correlation to patients' age, sex, skin complexion, type of incision, and type of skin sutures were studied.
  
  
  RESULTS
  The mean scar grading was 0.98 ± 1.0 and 1.3 ± 1.0 in patients' and examiner's assessment. About 27.5% described their scars as cosmetically significant. The cosmetic outcome was significantly affected by the type of incision with only 5% significant scars in subciliary incision group. Prolene 6-0 suture was associated with better cosmetic results with 15% significant scars. 50% of dark-skinned patients showed cosmetically significant scars. Although no correlation was found between patients' age and cosmetic outcome, pediatric patients showed higher tendency to scar visibility with mean scar grade 1.2 ± 1.0 and 1.5 ± 0.9 in patients' and examiner's assessment.
  
  
  CONCLUSIONS
  Dark skinned and pediatric patients are more prone to visible Ex-DCR scar. The use of subciliary approach and prolene 6-0 skin sutures is associated with more favorable cosmetic outcome.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Waly
authors.affiliation: Department of Ophthalmology, Oculoplastic Unit, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Osama E
authors.initials: OE
authors.lastname: Shalaby
authors.affiliation: Department of Ophthalmology, Oculoplastic Unit, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Molham A
authors.initials: MA
authors.lastname: Elbakary
authors.affiliation: Department of Ophthalmology, Oculoplastic Unit, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Aiman A
authors.initials: AA
authors.lastname: Hashish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000175:diagnosis / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000009:adverse effects*; D005143:Eyelids / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult