Eur Arch Otorhinolaryngol (2009) 266:1733–1738 DOI 10.1007/s00405-009-1000-1 123 RHINOLOGY Long-term results of endonasal dacryocystorhinostomy Johannes Zenk · Alexander D. Karatzanis · George Psychogios · Katrin Franzke · Michael Koch · Joachim Hornung · George A. Velegrakis · Heinrich Iro Received: 19 January 2009 / Accepted: 7 May 2009 / Published online: 26 May 2009  Springer-Verlag 2009 Abstract The aim of this study is to review the long-term results of endonasal endoscopic dacryocystorhinostomy (DCR) according to our experience as well as to evaluate potential prognostic factors for long-term outcomes. The Wles of 165 patients who underwent endonasal DCR at a tertiary referral centre between 1991 and 2001 were retro- spectively assessed. Furthermore, these cases were clini- cally evaluated at least 5 years after surgery and completed a subjective result evaluation questionnaire. A cure was reported by a total of 112 (67.9%) subjects and signiWcant improvement without need for further treatment was noted in 23 cases (13.9%). Thirty (18.2%) cases were considered as failures. The overall successful outcome according to the subjective symptom evaluation was 81.8%. Poor correla- tion between clinical Wndings and subjective report of symptoms was found. None of the prognostic factors that were assessed aVected outcomes signiWcantly. In conclu- sion, long-term success rates for endonasal DCR seem to be comparable to previously published short-term results. Keywords Dacryocystorhinostomy · Epiphora · Long-term results · Prognosis Introduction Endonasal dacryocystorhinostomy (DCR) is an established surgical method for the management of peripheral nasolac- rimal system obstruction [1]. For most part of the previous century, external DCR had been considered as the golden treatment standard for nasolacrimal duct obstruction [2]. During recent years, endonasal DCR has evolved as an alternative treatment option with signiWcant advantages, including wide surgical Weld, minimal intraoperative bleed- ing, avoidance of scarring, and preservation of the pumping action of the orbicularis oculi muscle. Moreover, these advantages are accompanied by comparable postoperative results [2, 3]. The endonasal approach was introduced by Caldwell and later modiWed by West [4]. Today, endonasal DCR is typi- cally performed by otorhinolaryngologists with the use of a nasal endoscope. Many diVerent technique variations have been reported. Conventional methods, as well as diVerent types of lasers, including CO 2 , holmium, Nd:YAG, KTP, and erbium, in addition to powered instruments, have all been utilised with comparable rates of success [1, 5, 6]. Successful use of a surgical microscope instead of an endo- scope as well as various transcanalicular approaches has also been previously reported [7–9]. Short-term results of endonasal DCR have been shown to be quite satisfactory [6, 10, 11]. Nevertheless, very limited data regarding the long-term results of endonasal DCR can be found in the literature [12]. Furthermore, no prognostic factors regarding the successful long-term outcome of endo- scopic DCR have been previously identiWed. In this study, we review the long-term outcomes of endonasal endoscopic DCR according to our experience. In addition, we evaluate potential prognostic factors for the successful treatment of nasolacrimal duct obstruction with this procedure. J. Zenk (&) · A. D. Karatzanis · G. Psychogios · K. Franzke · M. Koch · J. Hornung · H. Iro Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nurnberg Medical School, Waldstr. 1, 91054 Erlangen, Germany e-mail: johannes.zenk@uk-erlangen.de A. D. Karatzanis e-mail: akaratzanis@yahoo.com A. D. Karatzanis · G. A. Velegrakis Department of Otorhinolaryngology, Head and Neck Surgery, University of Crete Medical School, Heraklion, Crete, Greece