Kim and associates recently reported the results of their study regarding microbial growth on silicone tubes implanted during dacryocystorhinostomy (DCR).

Besides the limitations already pointed out by the authors concerning the study design and some of the methods employed, we would like to offer some comments regarding one of the main aims of the study, which was “to examine the association of the culture results with the surgical outcome.”

Our main concern is represented by the lack of information regarding the surgical technique used and the patient selection, which all directly influence the surgical outcome. In fact, there was no information regarding the osteotomy size and location, which probably are the most important factors related to surgical failure; the indications for endoscopic or external DCR procedures in their series were not stated; cases of revision DCR were included in the analysis, whereas it is known that those cases generally carry a higher risk of failure; and no information was provided regarding whether topical ocular and nasal postoperative anti-inflammatory treatment was employed.

We also noted that the authors always employed silicone tube stenting. Currently, in primary DCR without canalicular abnormalities, the evidence suggests that the success rate without tubes seems to be at least equivalent to that achievable when tubes are implanted. Therefore, the approach used is questionable.

Lastly, although systemic antibiotic treatment following DCR has been largely employed, the efficacy of this approach has been recently doubted.