Outcomes of Stentless Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction.

Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of persistent epiphora and recurrent lacrimal sac inflammation in adults, resulting from chronic inflammatory remodeling, fibrosis, and progressive narrowing of the distal lacrimal drainage system. Beyond physical discomfort, this condition can substantially interfere with daily activities such as reading, driving, outdoor activities, and social interaction. Endoscopic dacryocystorhinostomy (En-DCR) is a surgical treatment that bypasses the obstructed drainage pathway by creating a permanent communication directly between the lacrimal sac and the nasal cavity. Compared to traditional external approaches, En-DCR avoids a cutaneous incision, preserves the medial canthal anatomy, and allows for direct visualization and simultaneous management of relevant intranasal pathology. Historically, many surgeons have routinely placed silicone stents through the newly created rhinostomy to maintain patency and prevent soft-tissue stenosis during the healing phase. However, the routine use of silicone intubation in primary, uncomplicated cases remains a subject of ongoing clinical debate. Because stents act as foreign bodies, they carry inherent risks, including local mucosal irritation, tube displacement, punctal or canalicular trauma, granuloma formation, and corneal abrasion. Furthermore, stenting increases procedural costs and necessitates a dedicated follow-up visit for tube removal. This study operates on the rationale that the essential determinants of a successful En-DCR are the creation of an adequate bypass and favorable wound healing, rather than the temporary presence of a foreign body. Modern endoscopic techniques enable precise bony osteotomies, complete sac exposure, and meticulous mucosal flap preservation. By prioritizing the wide marsupialization of the lacrimal sac and implementing structured postoperative endoscopic care, the need for routine silicone intubation may be effectively eliminated for carefully selected patients. Participants enrolled in this study will undergo a standardized, stentless En-DCR. The surgical protocol emphasizes exposing the lacrimal bone and frontal process of the maxilla, creating a broad and dependent bony osteotomy, opening the lacrimal sac longitudinally, and preserving mucosal flaps for precise apposition without the insertion of bicanalicular or monocanalicular stents. Standardized postoperative management will involve targeted topical nasal saline irrigations and structured clinical visits for endoscopic cleaning, debridement, and the office-based management of any granulation tissue or synechiae as clinically indicated. By systematically documenting both subjective symptom resolution and objective endoscopic healing, this study seeks to provide robust clinical evidence detailing the healing patterns, failure mechanisms, and overall durability of stentless En-DCR.