Prevalence of Dacryocystitis and Epiphora After Rhinoplasty: A Retrospective Study

Abstract

Background: Rhinoplasty is among the most common cosmetic surgeries worldwide, including in Iran. Given the proximity of the nasolacrimal system to the surgical site, there is a potential for injury or infection transmission. Although rare, dacryocystitis and epiphora may occur postoperatively. Objectives: This study aims to investigate the prevalence and risk factors associated with these complications. Methods: In this retrospective cohort study, we reviewed the medical records of 124 patients aged 20 - 40 years who underwent rhinoplasty at Taleghani Hospital between January 2022 and December 2023. Inclusion criteria were a minimum of 3-month follow-up and no prior lacrimal pathology, rhinoplasty, or head/neck surgeries. Follow-up was conducted at 1 week, 1 month, and 3 months postoperatively. Outcomes were defined as clinically diagnosed dacryocystitis (characterized by swelling, erythema, and discharge near the medial canthus) and epiphora (persistent excessive tearing not explained by environmental causes). Logistic regression analysis was used to evaluate predictors of complications. Bias was reduced by excluding patients with prior lacrimal disease and standardizing follow-up assessments. Sample size was calculated based on a prior prevalence estimate of 3.6% for nasolacrimal obstruction, yielding a minimum of 81 cases, with all eligible patients included to improve power. All outcomes were assessed by an attending ophthalmologist during follow-up visits. Results: The mean age was 29.19 ± 5.2 years, and 71% were female. Dacryocystitis occurred in 2.4% of cases, exclusively among women. Epiphora was reported in 19.3% of patients at one week, decreasing to 3.2% at three months. Multivariate analysis showed that obesity (OR = 1.83, P = 0.009), female gender (OR = 0.72, P = 0.021), smoking (OR = 1.66, P = 0.006), and lateral osteotomy (OR = 1.6, P = 0.016) were significant predictors. Conclusions: The incidence of dacryocystitis following rhinoplasty is low but significantly associated with modifiable risk factors. Epiphora showed a declining trend over time. This study highlights the importance of preoperative risk assessment and surgical planning to minimize nasolacrimal complications.