Evaluating the Results of Endoscopic Dacryocystorhinostomy as Primary Treatment for Acute Dacryocystitis

The present study highlights the result of using endoscopic DCR as a primary treatment for acute dacryocystitis in adults. A retrospective case series study of 30 patients with nasolacrimal duct block and presenting with acute dacryocystitis with its complications like preseptal cellulitis, lacrimal empyema, with or without a spontaneous lacrimal fistula was done.

Oral antibiotics were simultaneously started. All patients were taken under intravenous sedation. All cases selected were operated by the same surgeon. The outcome was evaluated in terms of decrease in the swelling, pain and epiphora. The follow up was done 1wk, 4wks, and 6 months after surgery. At every follow up lacrimal syringing was done to establish the patency of the sac. The granulation tissue was cleaned every time endonasally. Intranasal infiltration was given in all planes to the anterior end of the middle turbinate. Mucosal flap was elevated maintaining haemostasis. Bony landmarks were identified and bone over the medial wall of the lacrimal sac was removed using these bony landmarks like anterior end of the middle turbinate and posterior margin of frontal process of maxilla. This study showed that endoscopic DCR can be used in complications of acute dacryocystitis like cellulitis and fistulas whereas previous studies were done in lacrimal empyemas. No DCR stents were used in this study.

The success rate of the surgery was 92.85%.

All surgeries were uneventful the sac area was much easier to identify due to its swollen nature. Some of the patients underwent a simultaneous septoplasty surgery due to the presence of a deviated nasal septum no DCR stents or tubes were used for the surgery. The first post-operative day the swelling and epiphora were reduced. The pain also reduced in all the patients but in 4 of the patients it reduced gradually over a period of 2 days. The lacrimal syringing showed patent lacrimal passages.

On subsequent follow up i.e. 1 wk and 1 month the osteotomy was cleaned of all the granulation tissue with suction endonasally. The osteotomy was patent at 6 months follow up in 26 patients.

The success rate after the combined treatment of endo-DCR, antibiotics and anti-inflammatory drugs was 92, 85%.