Abstract
Objective: To determine the outcomes of external dacryocystorhinostomy (Ext-DCR) in pediatric patients.
Methodology: This prospective, quasi experimental study included all pediatric patients who underwent Ext-DCR between Jan. 2018 to Nov. 2021 at Qazi Hussain Ahmad Medical Complex, Nowshera. Standard Ext-DCR surgery was performed in all the children with only anterior mucosal-flaps anastomosis. Demographics and baseline characteristics were recorded. Follow ups were conducted at 1st week, 4th week, 12th week and 25th week to see for any post-operative complication, success and failure of the procedure.
Results: Ext-DCR was performed on 140 eyes of 120 children. Mean age was
8.85±5.12 yrs. Watery eyes were the predominant symptom (93%, 130/140). Persistent congenital nasolacrimal duct obstruction refractory to earlier interventions of probing or intubation was the most common indication for the surgery noted in 84 (60%) patients. Adjuvants like mitomycin C and intubation were used in 92 (66%) and 87 (62%) surgeries, respectively. At 25th week follow-up, anatomical and functional success was noted in 129 (92.1%) and 125 (89.2%) patients, respectively. Eight eyes showed anatomical failure while two eyes showed functional failure. The most common cause of DCR failure was a granulation tissue/fibrous closure of the osteotomy seen in 7 out of 8(87.5%) patients.
Conclusion: Ext-DCR is an effective lacrimal drainage surgery with low failure rate in pediatric population with >90% success rate.

Key words: Dacryocyctorhinostomy, pediatric, congenital nasolacrimal duct obstruction, mitomycin C, epiphora.