Many studies have demonstrated the anatomic success of DCR operations, ranging from 80 to 95% [5, 6, 7, 8]. However, there are relatively few studies focusing on the patient’s perception of the operation and the postoperative result [14, 15]. Interestingly, several studies have found a lack of concordance between objective findings and patient satisfaction [16]. For this reason we focused specifically on the patients’ satisfaction with the result of DCR. Both external and endonasal DCR gave good results, according to the Lac-Q questionnaire. There was a considerable decrease in the Lac-Q score after surgery, regardless of which technique was used, indicating satisfaction with both kinds of operation. The average improvement in Lac-Q score was 10.05 points and 9.75 points for those undergoing external DCR and endoscopic DCR respectively. This difference was not significant. It can therefore be concluded that DCR alleviated the symptoms in the majority of patients, and that the patients were very satisfied. Only one patient regretted having undergone DCR.
It is well-known that epiphora reduces the quality of life [17] and its social impact should not be underestimated. Many of our patients with lacrimal stenosis not only complain of symptoms of epiphora, but also problems with social contacts preoperatively. Both groups reported rather high scores (143–147) in the Lac-Q questionnaire concerning social problems due to epiphora preoperatively. These values are in line with the results reported by Wong et al., in a prospective study [15]. Numerical scores allow comparisons, not only preoperatively and postoperatively, but, between problems associated with epiphora and other diseases. A significant reduction in the Lac-Q score postoperatively indicated the benefit of DCR in the social context. Future studies comparing the social impact of lacrimal problems and other conditions would be of interest.
One of the complementary questions was asked whether the scar posed a problem to the patients and 4 patients reported that it did. All the patients were informed about the scar if they chose the external DCR technique, and that the scar would be avoided with the endoscopic technique. It can be speculated that their lacrimal problems overshadowed the consequence of having a scar, but when these problems were resolved the scar became an issue. It is thus important to give patients adequate information on the various techniques available.
This was a retrospective study, and in the case of some patients two years had elapsed since their operation. There is thus a risk that their responses to the questionnaire were affected by time, resulting in them being more, or less, negative about their preoperative symptoms. However, the patients had had time to reflect on their previous symptoms and compare them to the postoperative result.
One of the factors affecting the choice of DCR approach is how long after the operation the patient has to stay at home before being able to return to work. It is commonly recommended that the patient remains at home for 2–3 days after a DCR, but we could find no studies on how long patients actually wait before returning to work. On average, the patients undergoing endonasal DCR stayed home one day less after the operation than those undergoing external DCR. The majority of patients recovered quickly, and those who worked returned to work after a few days. This study could confirmed that our recommendations for postoperative rest are in line with the actual period the patients remained at home.
To conclude, both external DCR and endonasal DCR gave good symptomatic relief for the majority of patients and no differences were found in patient satisfaction between the two groups.