Supplementary Material for: Bilateral, simultaneous common canalicular obstruction occurring ten years after endoscopic dacryocystorhinostomy: A case report

ABSTRACT
We report a case of bilateral, simultaneous late-onset common canalicular obstruction occurring over a decade after primary dacryocystorhinostomy (DCR), highlighting the diagnostic considerations of this unusual presentation. A 71-year-old female with prior sequential bilateral endoscopic DCR for nasolacrimal duct obstruction presented ten years postoperatively with spontaneous, simultaneous recurrence of bilateral epiphora and crusting discharge. Endoscopic examination demonstrated patent nasal ostia but bilateral common canalicular obstruction. The patient underwent revision bilateral endoscopic DCR with membranotomy and silicone intubation, achieving complete symptom resolution and lacrimal drainage at follow-up. Late onset complications following DCR are rare, however may be more often related to common canalicular obstruction. This case represents an exceptionally delayed presentation after primary surgery, expanding the known timeframe of DCR failure. The unusual bilateral and simultaneous nature of recurrence raises possibilities of underlying local or systemic inflammatory mechanisms contributing to this presentation.