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<p>Unilateral epiphora frequently coincides with ipsilateral deviated nasal septum (DNS), yet prospective data on prevalence, DCR outcomes with concurrent septoplasty, and underlying pathophysiology remain limited. To determine ipsilateral DNS prevalence in PANDO, assess whether concomitant septoplasty improves endoscopic DCR success, and identify anatomical/inflammatory correlates. A prospective single-centre study with an embedded randomized controlled trial was conducted from May 2025 to April 2026. Ninety-six patients with unilateral PANDO and ipsilateral DNS (angle ≥ 7°, Mladina II–VII) were randomized to DCR alone or DCR with concurrent septoplasty (n = 48 each). Primary outcome was functional success at 6&#xa0;months defined by MUSTAFA score ≥ 5/8, tear meniscus height ≤ 0.5&#xa0;mm, and Munk score ≤ 1. Secondary outcomes included surgical difficulty, operative time, complications, and inflammatory biomarkers (IL-8, TNF-α). Ipsilateral DNS was present in 92% of cases (p &lt; 0.001). The DCR + septoplasty group demonstrated significantly improved functional success (93.8% vs 79.2%, p = 0.038), reduced operative time (48.2 vs 56.7&#xa0;min, p = 0.002), and lower surgical difficulty scores (3.2 vs 7.8, p &lt; 0.001). Complication rates were lower in the combined group (8.3% vs 20.8%, p = 0.04). Biomarker analysis revealed greater reduction in IL-8 (71% vs 42%) and TNF-α (55% vs 25%), correlating with functional improvement. Recurrence rates at 12&#xa0;months were significantly lower in the combined group (6.3% vs 18.8%). Concurrent septoplasty significantly enhances surgical and functional outcomes in patients undergoing endoscopic DCR with ipsilateral DNS. These findings support routine evaluation and selective correction of septal deviation to optimize DCR success.</p>

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Ipsilateral Septal Deviation in Primary Acquired Nasolacrimal Duct Obstruction: A Prospective Study Evaluating Surgical Outcomes and Inflammatory Correlates with Concurrent Septoplasty

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • Rushikesh Harkut,
  • Roshni Mohanty,
  • Rahul Shenoy,
  • Shashikant Mhashal,
  • Amruta Tantak,
  • Abhijit Khandare

摘要

Unilateral epiphora frequently coincides with ipsilateral deviated nasal septum (DNS), yet prospective data on prevalence, DCR outcomes with concurrent septoplasty, and underlying pathophysiology remain limited. To determine ipsilateral DNS prevalence in PANDO, assess whether concomitant septoplasty improves endoscopic DCR success, and identify anatomical/inflammatory correlates. A prospective single-centre study with an embedded randomized controlled trial was conducted from May 2025 to April 2026. Ninety-six patients with unilateral PANDO and ipsilateral DNS (angle ≥ 7°, Mladina II–VII) were randomized to DCR alone or DCR with concurrent septoplasty (n = 48 each). Primary outcome was functional success at 6 months defined by MUSTAFA score ≥ 5/8, tear meniscus height ≤ 0.5 mm, and Munk score ≤ 1. Secondary outcomes included surgical difficulty, operative time, complications, and inflammatory biomarkers (IL-8, TNF-α). Ipsilateral DNS was present in 92% of cases (p < 0.001). The DCR + septoplasty group demonstrated significantly improved functional success (93.8% vs 79.2%, p = 0.038), reduced operative time (48.2 vs 56.7 min, p = 0.002), and lower surgical difficulty scores (3.2 vs 7.8, p < 0.001). Complication rates were lower in the combined group (8.3% vs 20.8%, p = 0.04). Biomarker analysis revealed greater reduction in IL-8 (71% vs 42%) and TNF-α (55% vs 25%), correlating with functional improvement. Recurrence rates at 12 months were significantly lower in the combined group (6.3% vs 18.8%). Concurrent septoplasty significantly enhances surgical and functional outcomes in patients undergoing endoscopic DCR with ipsilateral DNS. These findings support routine evaluation and selective correction of septal deviation to optimize DCR success.