Success rates for endoscopic and external dacryocystorhinostomy vary widely (external 70-95%; endonasal 59-99%). We investigated surgical preferences and reported success rates in dacryocystorhinostomy amongst American Society of Ophthalmic Plastic and Reconstructive Surgery members. This retrospective study utilized a questionnaire sent to American Society of Ophthalmic Plastic and Reconstructive Surgery members. Information culled included number of cases performed, surgical approach, and results. 214 (38% response rate) surveys were completed, representing over 7,054 cases in one year. 93.9% of respondents offer external dacryocystorhinostomy; 63.1% offer endonasal. Surgeons report an increased rate of post-operative tearing with endonasal versus external (35.6% versus 5.8%, p < 0.001) and post-operative dacryocystitis with endonasal versus external (13.2% versus 1.0%, p < 0.001). The top reasons for choosing endoscopic DCR were patient preference, no visible scar, and prior failed DCR. The top reasons for choosing external DCR were higher success rate, physician preference, and more long-term data on outcome. The majority of members use bicanalicular Crawford tubes (76%). Tubes were most commonly removed during post-operative months 2 (34.6%) and 3 (36.4%). Despite papers reporting equivalent success rates between external and endonasal dacryocystorhinostomy, more American Society of Ophthalmic Plastic and Reconstructive Surgery members perform greater numbers of external dacryocystorhinostomy, prefer external dacryocystorhinostomy, and report a higher success rate with this approach.
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