Background Dacryolith-induced epiphora is caused by a chronic obstruction of the nasolacrimal duct whose aetiology is often specified peroperatively. Dacryocystorhinostomy (DCR) has been often regarded as the gold standard to treat dacryolithiasis. Hasner’s valve (HV) incision is a technique to evacuate lithiasis through its physiological track. The purpose of this study was to describe clinical and radiological findings associated with presence of dacryoliths in patients who underwent surgery and to assess the efficacy of these two procedures. Methods This study was a comparative interventional multicentric retrospective study including patients referred for an epiphora. The primary endpoint was to determine clinical and endoscopic findings associated with dacryoliths. The secondary endpoints were to evaluate the performance of CT dacryocystography (CT-DG) in the diagnosis of dacryoliths and the success rate of the surgical treatment 6 months postoperatively. Results 4677 nasolacrimal ducts (NLDs) (78.0% female, mean age 59.2) were included in the study. 3913 underwent DCR, and 764 underwent HV incision. 291 out of 4677 NLDs (6.2%) were found to have dacryoliths. Presence of mucocele associated to a permeable lacrimal system (OR 8.17 (95% 4.62 to 14.44), p<0.01) was associated with presence of lithiasis peroperatively. Success rates at 6 months were 95.6% for endonasal DCR and 94.6% for incision of HV in dacryolithiasis group (p<0.01). CT-DG had a negative predictive value of 96.3% to detect lithiasis (p<0.01). Conclusion Strong clinical and endoscopic findings may improve the imputability of dacryoliths in epiphora. Evacuation of dacryolithiasis through its physiological track was first described in this study in adults with similar results to DCR in patients presenting with dacryolithiasis. All data relevant to the study are included in the article or uploaded as supplementary information. Data are all deidentified; they are available only from Dr Jean Marie Piaton in an Excel form.

中文翻译：

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泪石症的诊治：25年鼻内镜经验

背景 泪石引起的溢泪是由鼻泪管的慢性阻塞引起的，其病因通常在术中确定。泪囊鼻腔吻合术 (DCR) 通常被认为是治疗泪石症的金标准。Hasner 瓣膜 (HV) 切口是一种通过其生理通道清除结石的技术。本研究的目的是描述与接受手术的患者存在泪石相关的临床和放射学发现，并评估这两种手术的疗效。方法 本研究是一项比较介入性多中心回顾性研究，包括因溢泪而转诊的患者。主要终点是确定与泪石相关的临床和内窥镜检查结果。次要终点是评估 CT 泪囊造影术 (CT-DG) 诊断泪石的性能和术后 6 个月手术治疗的成功率。结果 4677 例鼻泪管 (NLD)（78.0% 为女性，平均年龄 59.2 岁）被纳入研究。3913 人接受了 DCR，764 人接受了 HV 切开术。4677 个 NLD 中有 291 个 (6.2%) 被发现有泪石。与可渗透泪道系统相关的粘液囊肿的存在（OR 8.17（95% 4.62 至 14.44），p<0.01）与术中结石的存在相关。在泪石症组中，鼻内 DCR 的 6 个月成功率为 95.6%，HV 切口的成功率为 94.6% (p<0.01)。CT-DG 检测结石的阴性预测值为 96.3% (p<0.01)。结论 强有力的临床和内镜检查结果可能会提高溢泪中泪石的可归因性。本研究首先在成人中描述了通过其生理轨道清除泪石症，其结果与泪石症患者的 DCR 相似。所有与研究相关的数据都包含在文章中或作为补充信息上传。数据全部去标识化；它们只能以 Excel 形式从 Jean Marie Piaton 博士那里获得。