1. Tears “well up” in my child’s eye(s) (Has 4 subtypes and 5 parameters to score).
2. Tears run down my child’s cheek.
3. My child has gunk in the corner of the eye(s).
4. My child’s eye(s) looks glassy.
5. The skin around my child’s eye(s) is red.
6. My child’s eyeball is red.
7. My child rubs his or her eye(s).
8. The appearance of one or both of my child’s eyeballs bothers me.
9. The appearance of one or both of my child’s eyelids bothers me.
10. Child is bothered by his or her eye(s)
11. Child’s eye condition interferes with his or her daily activities.
12. Child’s eye condition interferes with my daily activities.
13. I feel fine about my child’s eye(s).
14. I worry about my child’s eye(s).
15. Other people comment about my child’s eye(s).
16. I feel fine about the way my child’s eye(s) appears in photos.
17. Other children tease my child about his/her eye(s).
The author’s (Ali MJ) group has compared the parental quality of life (QOL) in CNLDO children who were successful following intervention versus complex CNLDO with poor outcomes. However, we did not include the last two (16, 17) questions. The early analysis has shown the Holmes questionnaire to be very useful for comparisons within the CNLDO group as well.
Quality of Life After DCR Surgery
The QOL after a DCR surgery has been usually assessed using the Glasgow-Benefit Inventory or GBI Questionnaire which was developed by Robinson et al. [5] for evaluating otorhinolaryngology procedures. This questionnaire is well known and validated in many studies across subspecialties of otology and rhinology [6, 7]. It consists of 18 questions, each assessed on a 5-point Likert scale; 12 questions are related to general perception of well-being and 3 each for physical health and social parameters. A positive GBI score represents a beneficial effect. The range of scoring extends from −100 (maximal negative benefit) to 0 (no change) to +100 (maximum positive benefit). Table 39.2 lists briefly the 18 questions that constitute the GBI.
Table 39.2
Brief Glasgow Benefit Inventory Questionnaire
1. Has the result of operation/intervention affected the things you do? |
2. Has the result of the operation made your overall life better or worse? |
3. Since your operation, have you felt more or less optimistic about the future? |
4. Since your operation, do you feel more or less embarrassed when with people? |
5. Since your operation, do you have more or less self-confidence? |
6. Since your operation, do you find easier or harder to deal with company? |
7. Since your operation, do you have more or less support from your friends? |
8. Have you been to your family doctor, more or less since operation? |
9. Since your operation, do you feel more or less confident about job opportunities? |
10. Since your operation, do you feel more or less self-conscious? |
11. Since your operation, are there more or fewer people who really care about you? |
12. Since you had the operation, do you catch colds or infections much or less often? |
13. Have you taken more or less medicine for any reason, since your operation? |
14. Since your operation, do you feel better or worse for any reason? |
15. Since your operation, do you have more or less support from your family? |
16. Since your operation, are you more or less inconvenienced by health problem? |
17. Since your operation, have you participated in more or fewer social activities? |
18. Since your operation, are you more or less inclined to withdraw from social situations? |
Bakri et al. [8] assessed the benefits of external DCR versus endoscopic laser-assisted DCR and found no statistical difference in GBI scoring between the two groups. Mansour et al. [9] studied the long-term patient satisfaction following an external DCR and concluded that long postoperative times negatively affects the exact subjective symptom scoring after surgery. Yeniad et al. [10] compared the patient satisfaction between external and transcanalicular laser DCR and found that the mean symptoms scoring reduced from 24.2 ± 4.6 at baseline to 3.5 ± 1.8 in the external group and 22.8 ± 3.4 to 3.37 ± 1.2 in the transcanalicular group (p = 0.67). The GBI scoring was similar and did not reach statistical significance in either group. However, there were concerns regarding follow-ups [11].
Ho et al. [12] studied the impact of endonasal DCR on QOL and found GBI scores of +34 in successful cases as compared to −19 in failed cases. The mean total GBI for endoscopic DCR in another study was +15.04 (95 % CI: 9.74–20.35). Hii et al. [13] compared patient satisfaction between external versus endonasal DCR and found no difference. When patients who underwent external DCR on one side and endonasal on the other side, retrospectively reported preference of endonasal DCR [14, 15]. In cases of bilateral NLDO, simultaneous bilateral DCR was shown to confer significant improvement of QOL with a statistically significant GBI score difference between 1 month and 3 months postoperatively [10].
Quality of Life in FNLDO and Minimally Invasive NLDO Treatments
Functional nasolacrimal duct obstruction is an underdiagnosed entity [16]. Epiphora in the presence of a patent lacrimal pathway and absence of alternative etiology could be the simplest description. Cheung et al. [17] conducted a detailed study on 33 FNLDO patients and studied their symptoms in relation to the vision, reading, driving, moods, work, and embarrassment. All these parameters were affected, specifically vision, reading, and embarrassment, resulting in lower quality of life. Overall symptom scores significantly reduced after dacryocystorhinostomy (DCR) from a mean preoperative score of 3.50 (SD = 2.07) to 2.0 (SD = 1.65) in the postoperative period (p < 0.05).
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