Fifty Years of Lacrimal Drainage System Disease Research (1975–2025): A Systematic Review and Meta-Analysis of Obstructive, Inflammatory, and Neoplastic Disorders

Abstract

Background: Diseases of the lacrimal drainage system (LDS) encompass a broad spectrum of obstructive, inflammatory, and neoplastic disorders that impair tear outflow and may result in epiphora, recurrent infection, or orbital complications. Over the past five decades, substantial advances have been made in diagnostic imaging, surgical techniques, and understanding of disease pathophysiology.
Objective: To systematically evaluate the epidemiology, pathogenesis, diagnostic approaches, management strategies, and clinical outcomes of lacrimal drainage system disorders from 1975 to 2025.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Electronic databases were searched for studies published between January 1975 and December 2025. Eligible studies included randomized controlled trials, cohort studies, case-control studies, and case series (≥10 patients) reporting outcomes of obstructive, inflammatory, or neoplastic LDS disorders. Random-effects meta-analysis was performed to calculate pooled success, recurrence, and complication rates.
Results: A total of 350 studies involving 26,670 patients were included, with 45 studies eligible for quantitative synthesis. Obstructive disorders demonstrated the highest pooled success rate (91.2%) and lowest recurrence (8.3%) and complication rates (6.5%). Inflammatory disorders showed slightly lower success (88.5%) and moderately higher recurrence (11.6%) and complications (9.8%). Neoplastic disorders exhibited significantly lower success (72.4%) and markedly higher recurrence (24.7%) and complication rates (18.2%). Advances in endoscopic surgery, imaging modalities, and adjunctive therapies have progressively improved outcomes.
Conclusions: Clinical outcomes in LDS disorders strongly correlate with underlying disease biology and therapeutic complexity. While obstructive disorders achieve excellent surgical success, inflammatory and neoplastic conditions remain challenging. Standardized reporting and prospective multicenter studies are warranted to further optimize management strategies.