Endoscopic 'cold steel' versus laser dacryocystorhinostomy: completing the audit cycle

Introduction: Dacryocystorhinostomy via an endonasal route has been adopted in our department. This audit study describes and compares our results for external, laser endonasal and 'cold steel' endonasal techniques. Success was defined as a subjective report of eye watering being 'better' or 'cured'. Data were obtained from a retrospective review of the medical records of all patients undergoing primary dacryocystorhinostomy in our department. 'Gold standard': External dacryocystorhinostomy performed by a consultant ophthalmologist was taken as our gold standard. In our study, the success rate for external dacryocystorhinostomy was 94 per cent. First cycle - laser-assisted endonasal dacryocystorhinostomy: Our initial results for endonasal laser-assisted dacryocystorhinostomy produced a success rate of 64 per cent, which was significantly worse than that for external dacryocystorhinostomy. These results have been previously published. Change in practice: Evidence suggested that cold steel endonasal dacryocystorhinostomy was more effective, and we adopted this as our technique of choice. Second cycle - cold steel endonasal dacryocystorhinostomy: Over a four-year period, 57 cases completed a full nine months' follow up. 93 per cent were completed as day cases and 39 per cent were performed under local anaesthetic. The success rate was 79 per cent (45/57). There was no difference in success rates when this procedure was compared with external dacryocystorhinostomy (p = 0.55). The type of anaesthetic used (i.e. local vs general) made no difference to the success rate (p = 0.93). Change in practice: Cold steel endonasal dacryocystorhinostomy was as effective as the gold standard, i.e. external dacryocystorhinostomy. Laser-assisted dacryocystorhinostomy was significantly less successful than external dacryocystorhinostomy. Due to the benefits of decreased operating time,, lower morbidity and success under local anaesthetic, we recommend cold steel endonasal dacryocystorhinostomy as our procedure of choice for the treatment of epiphora.