A Comparative Study of Conventional Versus Mitomycin C Augmented External Dacryocystorhinostomy

Abstract

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of chronic epiphora and recurrent dacryocystitis in adults. External dacryocystorhinostomy (DCR) remains the gold standard surgical procedure for treating nasolacrimal duct obstruction. However, postoperative fibrosis and closure of the osteotomy site may compromise long-term surgical success. Mitomycin C (MMC), an antifibrotic agent, has been used as an adjunct during DCR to reduce scar formation and improve ostium patency.

Methods: A hospital-based randomized interventional study was conducted in the Department of Ophthalmology, Jawaharlal Nehru Medical College, Ajmer, from June 2024 to May 2025. Eighty patients diagnosed with chronic dacryocystitis secondary to nasolacrimal duct obstruction were randomly allocated into two groups. Group A (n=40) underwent conventional external DCR, while Group B (n=40) underwent external DCR with intraoperative application of 0.2 mg/ml MMC for 5 minutes. Patients were followed on postoperative day 1, day 14, 3 months, and 6 months. Anatomical success was assessed by syringing patency and functional success by fluorescein dye disappearance test (FDDT).

Results: At 6 months, anatomical success was achieved in 92.5% of patients in the conventional DCR group and 97.5% in the MMC group. Functional success rates were similarly 92.5% and 97.5%, respectively. Postoperative complications were minimal in both groups. Granulation tissue formation was observed in only one patient in the MMC group. No revision surgery was required in either group.

Conclusion: External DCR is a highly effective procedure for managing nasolacrimal duct obstruction. Adjunctive intraoperative MMC demonstrated slightly higher anatomical and functional success rates with a comparable safety profile. MMC may be considered a useful adjunct in external DCR to improve long-term surgical outcomes.