Effect of endonasal dacryocystorhinostomy on conjunctival morphology and visual quality.

Clinical Relevance: Endonasal dacryocystorhinostomy (EN-DCR) is one of the preferred interventions for occlusion of the nasolacrimal drainage system. Understanding the bulbar conjunctival changes that occur after EN-DCR surgery will provide better insight into the effect of this procedure on visual quality and patient comfort.

Background: This study aimed to evaluate visual quality and bulbar conjunctival cytologic changes using in vivo confocal microscopy and corneal topography in patients with epiphora resulting from nasolacrimal duct obstruction after EN-DCR.

Methods: Nineteen eyes of 19 patients with epiphora were enrolled. All patients underwent EN-DCR with silicone tube intubation. Before and six months after EN-DCR, higher-order aberrations (HOAs) were measured using the Sirius corneal topographer/aberrometer, and bulbar conjunctival changes were assessed using in vivo confocal microscopy. Root mean square values of coma, trefoil, spherical, and total HOAs were analysed. Conjunctival superficial and basal epithelial cell and goblet cell densities and bulbar conjunctival changes were evaluated. The severity of epiphora was assessed by the Munk score before and six months after EN-DCR.

Results: Nineteen eyes of 19 patients (16 women and 3 men) were examined. The mean age of the patients was 40.8 ± 9.8 years. Total HOA and coma aberrations were significantly decreased at six months after EN-DCR compared to preoperatively. Conjunctival superficial and basal epithelial cell densities and epithelial thickness were significantly increased while goblet cell density was unchanged at six months after EN-DCR. There was also a significant improvement in Munk score six months postoperatively.

Conclusion: EN-DCR can lead to conjunctival remodelling. Alterations in HOAs and point spread function may occur during the postoperative period. Moreover, point spread function may be positively associated with Munk score.