Skip to main content
  • AAO OTAC Oculoplastics/Orbit Panel, Hoskins Center for Quality Eye Care


    A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel

    Suzanne K. Freitag, MD;1 Vinay K. Aakalu, MD, MPH;2 Jill A. Foster, MD;3 Timothy J. McCulley, MD;4 Jeremiah P. Tao, MD;5 M. Reza Vagefi, MD;6 Michael T. Yen, MD;7 Stephen J. Kim, MD;8 Edward J. Wladis, MD9

    Ophthalmology, Vol. 130, Issue 11, P1212-1220, © 2023 by the American Academy of Ophthalmology. Click here for free access to the OTA. 

    Purpose: To review the literature on the adjuvant use of mitomycin C (MMC) during dacryocystorhinostomy (DCR) in adults with primary nasolacrimal duct obstructions (NLDOs) to determine the efficacy in improving functional and anatomic outcomes with an acceptable level of risk.

    Methods: A literature search conducted in November 2020 and updated in November 2022 yielded 137 articles. Twenty-four articles met the inclusion criteria and were rated for level of evidence by the panel methodologist. Inclusion criteria required controlled studies on the effect of MMC on outcomes of external, endoscopic endonasal, or diode laser-assisted transcanalicular DCR in adults with

    Results: Six of the 24 articles were rated level I evidence, 15 level II , and 3 level III. In primary external DCR, MMC significantly improved functional outcomes in 3 of 9 series. In primary endoscopic endonasal DCR, MMC significantly improved functional outcomes in 1 of 9 series. In revision endoscopic endonasal DCR, MMC significantly improved functional success in 1 of 3 series. The use of MMC did not improve outcomes statistically in any diode laser-assisted transcanalicular DCR studies. Concentrations of MMC ranged from 0.05 to 1 mg/ml, with 0.2 mg/ml used most frequently in 12 series, with duration of application ranging from 2 to 30 minutes. Ostium size was significantly larger in MMC groups than in control groups at 6 months after surgery in 4 of 5 reporting studies. However, these larger ostia did not confer higher functional success rates. Reporting of adverse events related to MMC were rare, with delayed cutaneous wound healing reported in 1 of 750 patients.

    Conclusions: Intraoperative use of MMC in external and endoscopic endonasal DCR has been shown to improve functional and anatomic outcomes compared with controls in some series, but there is no agreement on the recommended concentration or application time for MMC in DCR. The data support that MMC use can result in a larger ostium size, decreased granulation tissue formation, and a decreased number of postoperative nasal debridements compared with controls, but this does not translate into improved functional success.

    1Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts 
    2Department of Ophthalmology and Visual Sciences; University of Michigan; Ann Arbor, MI 
    3Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio 
    4Department of Ophthalmology, John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas 
    5Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
    6Tufts University School of Medicine, Boston, Massachusetts 
    7Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 
    8Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee 
    9Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York