Safety and efficacy of silicone intubation compared to standard techniques in endoscopic dacryocystorhinostomy: a systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Described as statistically significant for primary outcomes; no specific p-values provided in abstract

• Effect Size: Not reported in abstract; directional benefit stated for success and failure rates; anatomical failure also reduced in stented group

• Primary Outcome: Statistically significant improvement in overall surgical success rates and reduction in overall failure rates in the silicone intubation (stented) group compared to the unstented group in EN-DCR

• Nnt Or Sensitivity: NNT not calculable from abstract data; no sensitivity/specificity or hazard ratio data provided; granulation tissue/ICO adverse events increased in stented group (direction reported, magnitude not quantified)

• Confidence Interval: Not reported in abstract

Clinical Application

Silicone intubation is a widely available technique in centres performing EN-DCR. The review acknowledges it is more resource-intensive than unstented EN-DCR. Stent placement requires additional operative time, materials, and a planned stent removal procedure, typically at 3–6 months post-operatively. The increased risk of granulation tissue formation and intracanalicular obstruction necessitates structured post-operative surveillance. Feasibility is high in tertiary ophthalmology and ENT centres but may be limited in lower-resource settings. In Australia, EN-DCR is performed by ophthalmologists and otolaryngologists, often in collaboration. Silicone stents (e.g., Crawford tubes, Ritleng intubation sets) are available through standard surgical supply chains and are not subject to specific TGA restrictions as implantable devices in this context. There is no specific PBS listing for silicone stents as a separately claimable item; costs are typically absorbed within the surgical episode. The RACGP and relevant specialist colleges (RANZCO, ASOHNS) do not currently publish specific guidelines on stenting in EN-DCR, meaning this meta-analysis could inform future position statements. Australian practice patterns vary between surgeons, with some routinely stenting and others reserving stents for revision cases — a practice pattern consistent with the review's conclusions. The finding of increased granulation/ICO in stented patients is clinically important for Australian practitioners planning post-operative review schedules. Adult patients with primary acquired nasolacrimal duct obstruction (PANDO) undergoing endoscopic DCR, particularly those with recurrent or revision cases where ostium patency is a primary concern

Abstract

BACKGROUND: Primary Acquired nasolacrimal duct obstruction (PANDO) is a lacrimal drainage disorder, commonly seen in adults. Endoscopic Dacryocystorhinostomy (EN-DCR) is a widely adopted surgical procedure for treatment of nasolacrimal duct obstruction. Silicon intubation is a technique, which involves inserting a soft silicone stent to keep the ostium patent post operatively. METHODS: This meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, with searches across 4 databases. Primary outcomes were overall success rate, and overall failure rate. Secondary outcomes included granulations/intracanalicular obstruction (ICO) threats, hemorrhage, anatomical failure, functional failure, recurrent symptoms/epiphora, and cicatricial stenosis/post-procedural restenosis. Data were analyzed using R software version 4.3. Heterogeneity was assessed using the I2 statistic. RESULTS: From 3,974 studies initially, 20 studies were selected in the final review, in which 17 were RCTs and 3 observational studies. A statistically significant improvement in surgical success rates, while reducing failure rates were observed in the silicone intubation (stented) group compared to the unstented group. No significant difference was observed in the incidence of restenosis, hemorrhage, functional failure, epiphora or recurrent symptoms. Reduction of anatomical failure was observed. Increase in adverse effects of granulation tissue formation and internal canalicular obstruction were observed. Heterogeneity was low and no publication bias was detected in outcomes. CONCLUSIONS: Silicone intubation during mechanical endoscopic dacryocystorhinostomy (EN-DCR) was associated with improved success and patency rates, as well as lower failure rate. While more resource-intensive, it provides a slightly higher advantage, particularly in recurrent or revision instances, recommending its implementation in routine EN-DCR where possible.

References

1. 1.Dar, A., Jalal, A. A., Ibrahim, M., Sadia, K., Irfan, H., Tariq, Z., Qasim, R., Khalid, G., Nasir, A., Hussain, D., Sajid, B., Nizam, R., Khalid, M., Tanveer, K., & Rifai, M. (2026). Safety and efficacy of silicone intubation compared to standard techniques in endoscopic dacryocystorhinostomy: a systematic review and meta-analysis. International Ophthalmology. https://doi.org/10.2147/OPTH.S482069