Orbital lobe dacryoadenectomy for refractory epiphora: a retrospective case series.

PURPOSE: To evaluate epiphora and ocular surface outcomes after macroscopically complete orbital lobe dacryoadenectomy with palpebral lobe preservation in selected patients with refractory epiphora after failed or intolerable conjunctivodacryocystorhinostomy (CDCR).

METHODS

This retrospective single-center case series included 11 consecutive patients with proximal canalicular obstruction and persistent epiphora after Jones tube failure or intolerance. The primary outcome was change in Munk score at 6 months. Secondary outcomes included Schirmer I, tear film break-up time (TBUT), lower tear-meniscus height, ocular surface findings, satisfaction, reintervention and complications.

RESULTS

All 11 patients improved by at least two Munk grades; median Munk score decreased from 4 (interquartile range [IQR], 3.5-4.0) to 1 (IQR, 1-2; exact Wilcoxon p = .001). Mean Schirmer I decreased by 4.91 mm/5 min (95% confidence interval, 3.15-6.67; p < .001) and mean TBUT by 1.05 s (95% confidence interval, 0.63-1.46; p < .001). Eight patients (72.7%) were satisfied or very satisfied and 10 (90.9%) were at least moderately satisfied. No patient underwent further lacrimal intervention or met the defined documentation based ocular surface event.

CONCLUSIONS

In this highly selected series, macroscopically complete orbital lobe dacryoadenectomy with palpebral lobe preservation was associated with substantial improvement in refractory epiphora after failed or intolerable CDCR. Reduced Schirmer I and TBUT support cautious patient selection and longer prospective follow-up.