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In the literature, there is some evidence to suggest that some treatments are superior to others, but there are no direct comparative data in this regard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective of review<\/jats:title><jats:p>To analyse the success rates of all available treatments to resolve post\u2010canalicular acquired lacrimal obstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Type of review:<\/jats:title><jats:p>Systematic review and meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy:<\/jats:title><jats:p>A literature search was conducted in the US National Library of Medicine (PubMed), EMBASE, SCOPUS and Cochrane databases with a final search performed in January 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evaluation method:<\/jats:title><jats:p>The search strategy identified articles published later than 2000 with at least 50 procedures performed both surgically (external dacryocystorhinostomy [EXT\u2010DCR], endoscopic dacryocystorhinostomy [END\u2010DCR] and transcanalicular laser dacryocystorhinostomy [TCL\u2010DCR]) and non\u2010surgically (balloon dacryoplasty [DCP], probing\u2010stenting [SP] and polyurethane stent [PoS]). The primary outcome was functional success, defined as symptom resolution or less than MUNK 2 scale; in addition to this, the influence of adjunctive treatments, such as application of mitomycin C and post\u2010procedural silicone stenting, was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 14\u00a0958 papers were selected, 440 of which were reviewed after screening; 55 were included after full\u2010text review, which involved 9337 procedures. Mean success rate was 48.9% (35.7%\u201062.3%) for DCP, 54.4% (41.8%\u201066.5%) for SP, 73.6% (59.7%\u201084%) for PoS, 80% (75.1%\u201084%) for TCL\u2010DCR, 89.8% (83.3%\u201093.9%) for EXT\u2010DCR and 89.5% (87.2%\u201091.5%) for END\u2010DCR. Among all procedures, a difference was noted between DCP and END\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), DCP and EXT\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), SP and END\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), SP and EXT\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), END\u2010DCR and PoS (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.016), and END\u2010DCR and TCL\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.001); no differences were noted between END\u2010DCR and EXT\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0=\u00a01.00), EXT\u2010DCR and PoS (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.121) and EXT\u2010DCR and TCL\u2010DCR (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.223). Considering surgical procedures, no differences were seen if a silicone stenting was applied, whereas, due to heterogeneity of the literature data, no statistical analysis was feasible for application of mitomycin C.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our analyses suggest that, among all procedures available, END\u2010DCR and EXT\u2010DCR should be considered as treatments of choice to resolve distal acquired lacrimal obstruction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13551","type":"journal-article","created":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T19:10:51Z","timestamp":1587237051000},"page":"545-557","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Best treatments available for distal acquired lacrimal obstruction: A systematic review and 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