Abstract ID: 26-386
Nasoseptal-to-Lacrimal-Fossa Distance Stratifies Revision Risk in Endoscopic Dacryocystorhinostomy
Author: Henry Bair Base Hospital / Institution: Wills Eye Hospital
Presentation Type: ePoster Presentation
Purpose
Diverse preoperative computed tomography (CT) findings before endoscopic dacryocystorhinostomy (DCR) are commonly treated as comparably actionable. We determined which findings predict surgical failure, separating quantitative corridor anatomy from background sinonasal inflammation and occult pathology.
Methods
Retrospective cohort of 521 consecutive endoscopic DCR patients (2018–2023). Preoperative CT was assessed for nasoseptal-to-lacrimal-fossa (NS-LF) distance, sinonasal inflammation, and occult pathology. A previously derived 8.85 mm NS-LF threshold stratified revision risk. Failure (ipsilateral revision DCR) was analysed by Kaplan-Meier and Cox regression.
Results
Failure rate was 4.4% (23/521) at median 259 days. NS-LF <8.85 mm conferred 2.4-fold higher revision hazard (HR 2.40, 95% CI 1.01–5.65, p=0.046); each additional millimetre reduced hazard by 23% (p=0.041). CT-reported septal deviation alone was not associated with failure (HR 0.64, p=0.35), indicating that measurement granularity, not septal pathology, drives predictive value. Inflammatory disease did not predict failure (chronic rhinosinusitis HR 1.81, p=0.27; nasal polyps and radiology-reported sinus disease nonsignificant). Occult findings were uncommon (2.2% of 497 imaged) but management-changing, including meningoencephalocele, meningioma, thyroid nodule, and sinonasal squamous cell carcinoma.
Conclusion
Preoperative CT findings do not carry equal weight before endoscopic DCR. We propose an anatomy-driven framework: NS-LF measurement guides septoplasty planning and revision-risk counselling, qualitative sinonasal findings do not defer surgery, and routine CT is reserved when septoplasty or ENT co-management is anticipated.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Emma | Anisman | Thomas Jefferson University Hospital |
| Pragya | Gupta | Thomas Jefferson University Hospital |
| Eshani | Ragam | Wills Eye Hospital |
| Alison | Watson | Wills Eye Hospital |
| Mindy | Rabinowitz | Thomas Jefferson University Hospital |
| Charlotte | Marous | Wills Eye Hospital |