Comparative assessment of hyperosmolar therapy after endonasal endoscopic dacryocystorhinostomy

BACKGROUND: Currently, endonasal endoscopic dacryocystorhinostomy is considered the most effective and safe surgical procedure for narrowing or obstruction of the lacrimal duct. There is now extensive clinical experience of this condition management, both diagnostic and postoperative. Nevertheless, relapses occurring in 10% of cases reduce the treatment effectiveness. They may be caused by granulomas at rhinostomy opening and intranasal synechiae. The outcome of endonasal endoscopic dacryocystorhinostomy largely depends on proper postoperative management. Today, hyperosmolar solutions are used postoperatively to improve outcomes of ocular surgery. However, there is few data on using these agents in nasolacrimal duct surgery.

AIM: The study aimed to evaluate the clinical effectiveness of hyperosmolar solutions in patients with postoperative edema of the conjunctiva and nasal mucosa after endonasal endoscopic dacryocystorhinostomy.

METHODS: The study was conducted at the Ophthalmology and Otorhinolaryngology Departments of Pavlov First Saint Petersburg State Medical University. Patients who underwent primary endonasal endoscopic dacryocystorhinostomy were enrolled. The control group received a combination medicinal product with antibacterial and anti-inflammatory effects, moisturizer, and topical nasal glucocorticosteroids for 1 month. The study group received 3% NaCl for irrigation of the conjunctival sac and a 21 g/L hypertonic saline intranasally in addition to the agents mentioned above. The effectiveness was assessed based on complaints of lacrimation and nasal breathing difficulties, biomicroscopy of the anterior segment, Norn test, endoscopy of the nasal cavity, and the results of lacrimal duct irrigation.

RESULTS: A total of 60 patients (62 eyes). Control group: 30 eyes, study group: 32 eyes were enrolled. In the study group, edema of the conjunctiva and nasal mucosa resolved by postoperative day 7. In the control group, severity of nasal cavity edema was 5% higher by day 7. By day 30, severity of nasal cavity edema was 1% and 5% in the study and control groups, respectively.

CONCLUSION: Postoperative therapy with topical hyperosmolar eye drops and nasal sprays after endonasal endoscopic dacryocystorhinostomy relieves edema of the nasal mucosa and lacrimal duct and prevents recurrent rhinostomy opening scarring.