Primary Endoscopic Dacryocystorhinostomy in Pediatric Patients: A Systematic Review

OBJECTIVE: Nasolacrimal duct obstruction (NLDO) in children typically resolves without surgery. Endoscopic dacryocystorhinostomy (En-DCR) is considered in cases refractory to irrigation, probing, and/or stent placement. The incidence of revision after pediatric En-DCR ranges from 0% to 22%. The objective of this review is to determine the incidence of revision and failure after pediatric En-DCR. DATA SOURCES: In this systematic review, Medline, Embase, and Cochrane databases were searched on 11/21/2025. REVIEW METHODS: Studies investigating primary, pediatric En-DCR outcomes were included. Case reports and articles that published no primary data or reported results aggregated with data from adult, revision, or external DCRs were excluded. Two reviewers (M.H. and R.W.) selected studies using these criteria and assessed quality with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. R V4.1.1 and GraphPad Prism 10.3.1 were used in statistical analysis and creation of Forest plots. The study protocol was pre-registered with Prospero. RESULTS: Thirty-one studies were included, involving 1470 ducts in 1230 patients. The mean age of these patients was 5.3 years old, and the study population was 49.5% male. Revision was performed in 9.1% of cases, and surgical failure occurred in 11.7% of cases. The mean follow-up time was 17.4 months. CONCLUSION: En-DCR is an effective treatment for NLDO. The incidence of revision was found to be lower than that of surgical failure, potentially due to short follow-up times of some studies or reluctance to undergo revision. The calculated incidence of complications and revision may underestimate true values due to significant heterogeneity among studies.