Purpose: To evaluate the reliability indices of 5-minute fluorescein dye disappearance test (FDDT) for anatomical and subjective successes after dacryocystorhinostomy (DCR) procedure and to propose a paradigm in assessment of patients with tearing after DCR.
Methods: In a retrospective study, results of FDDT (176 eyes of 176 patients) were tested against the success rates after both external (135 eyes) and endoscopic endonasal (41 eyes) DCR and bicanalicular silicone intubation. Subjective success was defined as no symptom or intermittent excess tear (without overflow) in cold weather and anatomical success as free passage on irrigation test. Irrigation was performed at the time of tube removal in 58 eyes and at the last follow up in 118 eyes. Fluorescein dye disappearance test and subjective success were assessed either 1 week after tube removal (58 eyes) or at the last follow up (118 eyes). Grades 0 and 1 were considered as negative FDDT, and grades 2 and 3 as positive FDDT.
Results: Included patients who had primary acquired (94.9%) and traumatic (5.1%) nasolacrimal duct obstruction had a mean age of 49.8 years and a mean follow up of 11.7 months. There were 15 cases with previously failed DCR. The mean time of tube removal was 7.2 weeks (SD = 2.2). Final anatomical and subjective success rates were 95.5% (168/176) and 92% (162/176), respectively. Fluorescein dye disappearance test showed a sensitivity of 100% and a specificity of 86.3% for the anatomical success. They were 85.7% and 88.2% for the subjective success, accordingly.
Conclusions: All anatomically failed DCR showed a positive FDDT (100% sensitivity) in this series. The proposed paradigm offers a less invasive approach to post-DCR epiphora.