The effectiveness of simultaneous medial spindle and/or lateral tarsal strip procedure in East Asian patients who need endonasal dacryocystorhinostomy

Backgrounds: To evaluate the effectiveness of simultaneous medial spindle procedure (MS) and/or lateral tarsal strip procedure (TS) with an endonasal dacryocystorhinostomy (DCR) for treatment of involutional medial punctal ectropion, horizontal eyelid laxity, and nasolacrimal duct obstruction. Methods: We conducted a retrospective, interventional study of DCR performed from March 2009 to July 2011 by a single surgeon (Baek SH). Patient age, sex, results of medial and lateral distraction test, surgical procedure, time of tube removal, duration of follow-up, functional and anatomical success rate, and causes of failed surgeries were recorded. Lateral lower eyelid laxity was evaluated by a medial distraction test, and medial lid laxity was evaluated by a lateral distraction test. Results: A total of 241 eyes in 175 patients were included in this study. The proportion of combined surgeries to total DCR was 24.5 % (59 of 241 eyes). DCR and MS (D + M) were performed on 23 eyes in 17 patients (9.5 %) and DCR and TS (D + T) on 29 eyes in 17 patients (12.0 %). Concurrent DCR, MS and TS (D + M + T) were performed on seven eyes in four patients (2.9 %). Mean age was significantly higher in the combined surgery groups (63.8 ± 10.0 years) than in the DCR group (56.2 ± 10.6 years; p = 0.01, by Mann-Whitney U test). The anatomical success rates were 84.2 % in D, 86.9 % in D + M, 89.5 % in D + T, and 85.7 % in D + M + T (p = 0.61 by Kruskal-Wallis test). Functional success rates were 82.4 % in D, 86.9 % in D + M, 86.2 % in D + T, and 85.7 % in D + M + T (p = 0.91 by Kruskal-Wallis test). Conclusions: MS and TS performed concurrently with a DCR may be an effective tool to deal with epiphora due to complex clinical situations such as nasolacrimal duct obstruction, lid laxity, and involutional medial ectropion. It is recommended to examine punctum and lid laxity carefully using slit-lamp biomicroscopy and lid distraction test in patients with epiphora, especially in elderly patients.