Evaluation of meibomian glands and tear parameters before and after dacrycystorhinostomy in patients with primary acquired nasolacrimal duct obstructions

Purpose: To investigate the effects of epiphora due to primary acquired nasolacrimal duct obstruction (PANDO) and external dacryocystorhinostomy (DCR) for its treatment on meibomian glands and tear film parameters. Material and Methods: In this study, the files of 17 patients who met the criteria for inclusion from patients undergoing external DCR for unilateral PANDO in the Department of Ophthalmology, Faculty of Medicine, Bursa Uludag University between January 2018-June 2019 were retrospectively reviewed. The tear film parameters and meibography measurement recorded at the preoperative and postoperative first month examinations were examined on both the obstructed side and the patent side. Results: There was a significant difference between Schirmer-1 score before external DCR (13,1±5,0; 6,3±5,0; p=0,01) and this difference disappeared after surgery (12,0±7,3; 7,7±5,0; p=0,06). Postoperative increase in non-invasive average break-up time (niABUT) on operated side was statistically significant (10,5±4,6; 12,0±5,3; p=0,033). When the healthy and operated sides were compared with each other, no significant difference was observed in niABUT before and after surgery (p=0,907, p=0,614). Mean meibomian gland losses were decreased in both operated and patent sides postoperatively and these values were statistically significant (33,0±8,2; 27,1±6,8; p<0,001, 37,3±10,4; 31,4±9,6; p=0,01). Conclusion: Patients with unilateral nasolacrimal duct obstruction (NLDO) had loss of meibomian gland in both NLDO side and patent side. This loss was found to be significantly reduced on both obstructed and patent sides after successful surgical removal of the epiphora. Prospective studies with a large number of patients are needed for the emergence of pathways supporting this finding. Keywords: Epiphora, dacryocystorhinostomy, meibomian gland, nasolacrimal duct