Surgical success of 'W' shaped incision versus Tear Trough incision in External Dacryocystorhinostomy

Purpose: To compare surgical success (cosmetic, anatomical & functional) of W' shaped incision versus tear-trough incision in external dacryocystorhinostomy (eDCR). Methods: In a prospective study (November 2018 - March 2020), 61 eyes of chronic dacryocystitis underwent eDCR randomized into group T (30 eyes) & group W (31 eyes). The functional and objective cosmetic assessment was done at 3 months using Munk's and Devoto's scores respectively. The subjective cosmetic evaluation was done using a questionnaire. Grades 0-1 were considered the cosmetic and functional success after assessing the respective scores. The patent lacrimal passage was defined as anatomical success. Results: Mean age was 40.1 +/- 14.9 years with female preponderance. Intraoperative skin flap button-holing & reversible darkening of their apices were specific complications of Group W. In the early postoperative period, lid edema & epiphora were significantly more in group T (p < 0.05). The functional success rate in group T and W was 93.3% and 93.5%, respectively (p = 0.53). There was a 100% anatomical success rate in group T whereas 96.8% in group W (p = 0.51). The subjective cosmetic success rate was 83.3% in group T and 80.6% in group W (p = 0.78) while objective cosmetic success rate was 63.3% and 67.7% in group T and group W, respectively (p = 0.72). Conclusion: Surgical success in terms of cosmetic, anatomical & functional outcomes of W-shaped incision were comparable to the conventional Tear trough incision.