Cutaneous scar visibility after external dacryocystorhinostomy: A comparison of curvilinear and W shaped incision.

Purpose: The major drawback of an external dacryocystorhinostomy (ExDCR) is visible skin scar leading to poor patient satisfaction. In this study we have analyzed the skin scarring objectively after Curvilinear incision (CLI) and W shaped incision (WSI).

Methods: This is prospective trial done at Department of Ophthalmology at tertiary level hospital. All the patients with primary acquired nasolacrimal duct obstruction were included in the study. Patients were assigned to group A(CLI) or Group B (WSI). Cosmetic outcome was assessed by scar visibility at 1st, 3rd and 6th month postoperatively by two ophthalmologists separately, who were unaware of incision type.

Results: We studied 64 patients with median age 59.0 years (IQR [Interquartile range]: 50.0-66.8 years). Scar visibility was significantly (p = 0.001) more in WSI group at all follow-ups. None of the patients of CLI group showed visible scar at six months whereas ten patients (31.3%) of WSI group still had minimal scar (p < 0.001). Older patients had significantly less scar than younger patients. The time taken to perform ExDCR was significantly more with WSI (41.0 min, IQR: 40.0-44.0 min) than for CLI (33.0 min., IQR: 31.3-35.0 min); p < 0.05. Overall complication rates were similar in both the groups (p > 0.05) but extension of skin incision was more common in WSI group.

Conclusions: We found that CLI is more aesthetic, simpler, requiring less operative time and less incision related complications when compared with WSI.