Lacrimal drainage system patency following one month versus three months of lacrimal intubation removal after external dacryocystorhinostomy: A randomize, comparative clinical trial

External dacryocystorhinostomy (Ex-DCR) is a common procedure for the treatment of nasolacrimal duct obstruction (NLDO). The aim of this study is to study the relationship between timing of silicone tube removal and outcome after Ex-DCR which isn?t clearly defined in the literature and ranges from a few weeks to a year post-operativelyWe plan to prospectively recruit candidates of adult group population with a diagnosis of NLDO to undergo Ex-DCR with silicone intubation. The patients will be randomly assigned pre-operatively to one of two groups; silicone tube removal at 1 month and at 3 months. The randomization is computer generated. Both the surgeon and patient will be blinded to the timing of anticipated tube removal throughout the pre-operative period and at the time of surgery. The surgery will be performed by the same surgeon using the same technique and consumables for all cases. Post-operatively, all patients will receive antibiotic ointment to be applied over the wound twice daily for 2 weeks and antibiotic drops four times daily for one week. Oral antibiotic will be prescribed as needed. Follow up visit will be scheduled as one week, one month, three months, six months and twelve months from the time of surgery. During period of follow up one group of patients will get tube removal after one month while the other will get it after three months. The whole process of tube removal will be done blindly.Knowledge of the ideal timing of tube removal not only will influence the success rate of surgery, but also will avoid the need for unnecessary follow up and probably repeating surgery and hence reduce the cost of patient care. Some surgeons advocate re-intubation if the tube was lost in the early post-operative period. If the study proved no difference in tube removal timing, such procedure would be unnecessary. Furthermore, silicone intubation placement is not without complications (infection, migration) and the more it is left in place, the higher the chances of complications development. If early tube removal made no difference in the success rate, then early tube removal to reduce the rate of complications and reduce patients? discomfort and thus reduce cost of patient care may be advocated.