To ascertain the prevalence of air reflux after external dacryocystorhinostomy, its natural history, and its relation to symptomatic cure.
More than a year after lacrimal surgery, patients were contacted via a structured telephone interview and were questioned about air reflux and lacrimal symptoms.
Interviews were completed by 77 patients (98 operations). Postoperative air reflux had been noted after 46 of 98 operations (47%) and persisted in 36 of 46 eyes (78%), at a mean follow-up of 58 months. Reflux occurred in 36% (8 of 22) of eyes after membranectomy, a rate similar to that without membranectomy (38 of 76 eyes; [50%]); the relative risk of air reflux with membranectomy was 0.7 (95% confidence interval, 0.4-1.3; P = .30). Overall, symptomatic improvement was achieved in 85% of procedures (83 eyes). Reflux was associated with a higher success rate (relative risk, 1.22; P = .02) and was significantly less likely to be associated with unchanged or worse symptoms (relative risk of failure, 0.28; P = .03).
Air reflux is common after external dacryocystorhinostomy, is associated with symptomatic success, and generally persists but is rarely troublesome. Membranectomy does not increase the incidence of reflux, suggesting that the valve of Rosenmüller may not act as a 1-way valve for air flow.