Effects of ostium granulomas and intralesional steroid injections on the surgical outcome in endoscopic dacryocystorhinostomy

  • Aerin Jo
  • Shin-Hyo Lee
  • Wu-Chul Song
  • Hyun Jin ShinEmail author
Oculoplastics and Orbit



To determine the effect of granuloma formation in the ostium and intralesional steroid injections (ISIs) on the surgical outcome after endoscopic dacryocystorhinostomy (DCR) in patients with primary acquired nasolacrimal duct obstruction (PANDO).


One hundred and eighty-three cases involving 142 patients were enrolled. The ostium granulomas were classified according to their location relative to the internal common opening (superior, anterior, and posterior positions) and to the vicinity of the ostium (inner, edge, and extra types). If an ostium granuloma was observed during the follow-up and its size increased, ISIs were performed using 0.3 ml of 40 mg/ml triamcinolone acetonide. The surgical outcomes were compared between cases with and without ostium granulomas and also between each granuloma position and type.


Ostium granulomas occurred in 71 (38.8%) of the 183 cases, and an ISI was applied in 65 cases with a mean of 2.1 injections. All of the granulomas regressed successfully after ISIs, with the success rate not differing between the cases with (85.9%) and without (83.9%) granuloma. There was no association between granuloma location and surgical outcome. However, the functional outcome was worse (60%) for inner granulomas (which are located within the ostial base) than for extra (87.8%) and edge (98%) granulomas.


ISIs can be easily applied by a surgeon to help regress an ostium granuloma and improve the ostial patency after DCR. Inner ostium granulomas are associated with a worse functional outcome, and the initiation of an early corrective intervention such as an ISI should be considered.


Dacryocystorhinostomy Intralesional steroid injection Ostium granuloma Functional outcome 


Author contributions

HJ Shin designed the study and revised the manuscript. SH Lee and WC Song collected data. A Jo wrote the manuscript.


This work was supported by the Konkuk University Medical Center Research Grant 2017 (No. 201711). This sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology, Konkuk University Medical CenterKonkuk University School of MedicineSeoulRepublic of Korea
  2. 2.Department of AnatomyKonkuk University School of MedicineSeoulRepublic of Korea

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