Consequences of Premature Silicone Stent Loss Following Endonasal Dacryocystorhinostomy

Background Premature silicone stent loss after primary endonasal dacryocystorhinostomy (enDCR) may affect lacrimal drainage surgery outcomes, but its impact on surgical success is uncertain. Objectives To determine whether premature silicone stent loss (<2 months) after primary enDCR affects surgical success. Design Single-centre retrospective cohort study. Methods Single-centre retrospective cohort conducted at Hadassah Medical Center, including adults with primary acquired nasolacrimal duct obstruction who underwent primary enDCR with bicanalicular intubation between August 2020 and December 2024. The primary outcome was surgical success -absence of symptomatic epiphora/infection and/or patent lacrimal irrigation - assessed ≥3 months postoperatively. Outcomes were compared between eyes with “premature” stent loss and those without (“late”). Results We included 107 eyes (mean age 60.3±17.8 years; 72.9% female). Median follow-up was 239 days (IQR 137–592). Premature stent loss occurred in 21 eyes (19.6%), with a median time to loss of 14 days (range 6–35). Overall surgical success was 86.9% (93/107). Success was comparable between premature and late groups: 85.7% (18/21) vs 87.2% (75/86), p=1.00. Complications were uncommon (2.8% overall) and similar between groups (4.8% vs 2.3%, p=0.48). Revision surgery was required in 12.1% overall (14.3% premature vs 11.6% late, p=0.72). Most premature losses occurred within 30 days, and early loss was not associated with surgical failure. Conclusions In primary enDCR with bicanalicular intubation, premature stent loss within two months was not associated with reduced surgical success or higher reoperation rates. Conservative management with close follow-up is reasonable after early loss, and shorter stent-retention protocols may be considered; prospective studies should define the optimal duration.