Use of topical ocular antihypertensives may lead to dacryocystorhinostomy failure

A recent retrospective study assessed whether the use of topical ocular antihypertensives affected outcomes of dacryocystorhinostomy (DCR) with intubation.

Study design

Records from 170 dacryocystorhinostomy (DCR) operations on 144 patients conducted at a single center in the United Kingdom over a 5-year period were reviewed. Failure rates of surgery were compared between those patients on topical ocular antihypertensives and those not on therapy.

Outcomes

The overall failure rate of the DCR surgery was 11.2%, and there was no difference in failure rate between the endonasal and external approaches. About 7% of patients were on topical antihypertensives, and these patients had significantly more DCR surgery failures than patients not on therapy. Carbonic anhydrase inhibitors and beta-blockers were the most commonly used agents.

Limitations

There are known systemic causes of nasolacrimal duct obstruction (NLDO) which are associated with a greater risk of DCR failure. The investigators did not note whether there was a systemic association of NLDO within their population of patients. One of the definitions of failure used in the study was anatomical patency but symptomatic epiphora. It is possible that the topical therapy was causing reflex tearing in these patients. Last, the use of confidence intervals would have helped to better delineate the significance of the differences noted.

Clinical significance

Previous studies have shown an increased prevalence of NLDO in patients on topical glaucoma therapy. This study adds to those previous reports, showing that DCR surgery failure is more likely in those patients taking topical antihypertensives. This may be due to mucosal fibrosis triggered by the topical therapy. It may be useful to counsel patients on glaucoma drops who will undergo DCR surgery about the increased risk of surgery failure.