IntroductionThe optimal approach for paediatric dacryocystorhinostomy (DCR) remains debated with increasing adoption of endoscopic techniques despite variable outcome reporting. This study compared success, revision and complication rates between endoscopic and external paediatric DCR.
Methods
A PRISMA-guided systematic review identified studies reporting outcomes following primary paediatric (<18 years) endoscopic or external DCR. Random-effects meta-analysis was performed to pool success, revision and complication rates. Subgroup analysis compared outcomes between approaches. Follow-up duration between groups was also assessed.
Results
Twenty studies were included (14 endoscopic; 6 external). External DCR demonstrated significantly higher pooled success rates than endoscopic DCR (94.4% vs 84.6%, p<0.001). Revision surgery was significantly more common following endoscopic DCR (7.2% vs 1.8%, p=0.003). Complication rates were low in both groups and did not differ significantly (5.1% vs 8.7%, p=0.229). Follow-up duration was comparable between techniques (median 14.4 vs 8.8 months, p=0.186).
Conclusion
External paediatric DCR was associated with higher pooled success rates and lower revision burden compared with endoscopic DCR, without a significant difference in complications. These findings suggest external DCR may provide more reliable primary outcomes. However, interpretation is limited by study heterogeneity and the predominantly retrospective evidence base. Prospective comparative studies with standardised outcome reporting are required.