Symptom Score Questionnaire for Nasolacrimal Duct Obstruction (NLDO) in Adults – A novel tool to assess impact on quality of life after Endoscopic Dacryocystorhinostomy
Abstract
Dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat nasolacrimal pathway obstruction. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. A specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire was develop to evaluate the outcome and tested it in a prospective. Primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 60 patients during 2013-2014. Preoperatively and during the three follow-up (3 month, 6 months and 12 months ) visits, the patients were asked to fill the NLDO-SS along with Glasgow Benefit Inventory (GBI) questionnaire. The success rate of EN-DCR was 91.67%. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-S. The GBI scores indicated a benefit at 3 months and more benefit at 6 months, but no further improvement was found between 6 and 12 months. The correlation between the total GBI and NLDO-SS was significant. EN-DCR improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and ENDCR benefits.
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Introduction
Obstruction of the nasolacrimal pathway is a common disorder, especially in elderly patients, clinically manifested by the presence of tearing and/or infection (Woog 2007).1 In majority of cases the cause of obstruction is idiopathic. Such becomes more common with increasing age and shows a female preponderance.2
The definitive treatment is the creation of a fistula from the lacrimal sac into the nose. This procedure is mainly used to treat distal outflow obstruction to the nasolacrimal system.3 There are various methods of performing dacryocystorhinostomy for the treatment of nasolacrimal duct obstruction. Endoscopic dacryocystorhinostomy is becoming more popular, compared with conventional external dacryocystorhinostomy. 2,3 The endonasal approach to the lacrimal sac was first described by Caldwell in 1893. 4
The symptoms of nasolacrimal duct obstruction (NLDO) were described in papyrus documents by the ancient Egyptians. (Hirschberg 1982)5 . Tearing, blurred vision, periorbital pain, and recurrent infections in the lacrimal sac, may significantly deteriorate individuals’ quality of life (Qol).
Conclusion
This present study indicates that the NLDO-SS questionnaire provides more information for subjective postoperative outcome assessment after EN-DCR, thus it is novel tool. Furthermore, for better assessment it requires studies on more number of patients and for longer postoperative follow-ups.