Purpose

To evaluate the incidence, risk factors, and outcomes of unexpected stent extrusion and involuntary stent loss following dacryocystorhinostomy (DCR) with silicone intubation, and to identify predictors of surgical failure.

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Methods

Retrospective cohort of 839 DCRs (673 patients) at a tertiary center (2016–2026). Over 25 patient, surgeon, and surgical characteristics were tested on univariable and multivariable logistic regression.

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Results

Anatomic, functional, and combined failure rates were 11.4%, 11.3%, and 13.9%. Secondary acquired nasolacrimal duct obstruction (SANDO) was associated with higher anatomic failure than primary acquired nasolacrimal duct obstruction (PANDO) (16.3% vs. 10.2%, p=0.032). Combined failure was associated on univariable analysis with stent loss (p=0.002), stent suture (p=0.039), and any stent event (p=0.042). Kenalog (p=0.006) was protective. On multivariable analysis, complete nasolacrimal duct obstruction (NLDO) predicted anatomic failure (p=0.028) and stent loss predicted functional failure (p<0.001).

Unexpected stent extrusion occurred in 16.9% and stent loss in 3.9%. Extrusion generated unplanned visits in 55.6%, representing a significant use of healthcare resources. Reinsertion yielded no significant outcome benefit and re-extrusion occurred in 48.9%. Univariable predictors of extrusion: functional NLDO (p=0.010), dementia (p=0.025), acute dacryocystitis (p=0.039). Functional NLDO was the only independent predictor (p=0.009). Extrusion did not significantly compromise combined success (p=0.418), whereas stent loss markedly reduced it (p=0.003). Male sex (p=0.008) and stent suture (p=0.037) independently predicted stent loss.

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Conclusion

To our knowledge, this is the largest study to systematically characterize risk factors for premature stent events and their impact on DCR outcomes. Unexpected stent events independently predict combined failure, with complete stent loss carrying the greatest impact. These data support risk-stratified counseling, and reconsideration of stent reinsertion and of routine suture fixation.

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Additional Authors

First name	Last name	Base Hospital / Institution
Simon	Elsliger	Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
Victoria	Prudy-Millaire	Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
Myriam	Belaiche	Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
Jad	Chedid	Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
Elie	Abi-Khalil	Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
Evan	Kalin-Hajdu	Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada

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