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VOLUME 5 , ISSUE 3 ( September-December, 2012 ) > List of Articles

RESEARCH ARTICLE

Acute Dacryocystitis with Abscess: Endonasal Dacryocystorhinostomy, the Primary Treatment of Choice

Sudhir Naik

Keywords : Dacryocystitis,Lacrimal abscess,Incision and drainage,Endoscopic dacryocystorhinostomy

Citation Information : Naik S. Acute Dacryocystitis with Abscess: Endonasal Dacryocystorhinostomy, the Primary Treatment of Choice. Clin Rhinol An Int J 2012; 5 (3):107-113.

DOI: 10.5005/jp-journals-10013-1129

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2012; The Author(s).


Abstract

Background/objectives

Acute dacryocystitis, or inflammation of the lacrimal sac with abscess, is almost always secondary to nasolacrimal duct obstruction. The standard practice for treatment is incision and drainage because of concerns about the risks of exacerbation and spread of infection. Here, we tried to evaluate primary endoscopic dacryocystorhinostomy (EnDCR) as a treatment for acute dacryocystitis with abscess formation.

Materials and methods

This is comparative case series analysis study done during the study period of 54 months from January 2007 to May 2011. A total of 46 cases of acute dacryocystitis with lacrimal abscess managed were included in the study. Twenty-one cases were operated primarily with EnDCR. Rest of the 25 cases was managed conventionally by incision and drainage and later by an external DCR.

Results

Swelling disappeared intraoperatively in all EnDCR cases while medial canthal edema and erythema completely reduced within 2 to 3 days postoperatively. While in incision and drainage swelling disappeared partially intraoperatively and repeated draining was needed on the 2nd and 3rd day. The mean visual analog scale (VAS) score on first postoperative day was 3.14 in group A and was 4.64 in group B. Group A had faster pain relief with 95.23% improvement in epiphora while group B had slower pain relief but epiphora remained. Mean intraoperative blood was 65 ml in group A and minimal in group B.

Conclusion

Primary EnDCR is successful as a procedure of choice for acute dacryocystitis with abscess preventing further episodes of abscess formation and epiphora in the patients. We recommend EnDCR as the treatment of choice for acute dacryocystitis with lacrimal abscess.

How to cite this article

Naik SM, Naik SS. Acute Dacryocystitis with Abscess: Endonasal Dacryocystorhinostomy, the Primary Treatment of Choice. Clin Rhinol An Int J 2012;5(3):107-113.


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  1. Basic and clinical science course: Orbit, eyelids and lacrimal system. San Francisco, CA: American Academy of Ophthalmology; 1998:1-269.
  2. An analysis of patients with chronic dacryocystitis. Pak J Ophthalmol 2003;19(3):77-83.
  3. Idiopathic acquired lacrimal drainage obstruction. Br J Ophthalmol 1967;51(7):463-68.
  4. Comparative bacteriology of acute and chronic dacryocystitis. Eye 2008;22(7):253-60.
  5. Bacteriology and antimicrobial susceptibility of adult chronic dacryocystitis. Nepal J Ophthalmol 2010;2(4):105-13.
  6. Management of acute dacryocystitis in adults. Ophthal Plast Reconstr Surg 1993;9:38-41.
  7. Endonasal laser dacryocystorhinostomy. A new approach to nasolacrimal duct obstruction. Arch Ophthalmol 1990;108:1172-76.
  8. Holmium YAG endonasal laser dacryocystorhinostomy. Am J Ophthalmol 1993;116: 1-10.
  9. Endonasal dacryocystorhinostomy in the primary treatment of acute dacryocystitis with abscess formation. Ophthal Plast Reconstr Surg 2001;17:180-83.
  10. Primary endoscopic dacryocystorhinostomy as treatment for acute dacryocystitis with abscess formation: Am J Otolaryngol Head Neck Med Surg 2008;29:177-79.
  11. Primary treatment of acute dacryocystitis by endoscopic dacryocystorhinostomy with silicone intubation guided by a soft probe. Ophthalmology 2009 Jan;116(1):116-22.
  12. The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy. Br J Ophthalmol 2004;88:139-41.
  13. Endonasal dacryocystorhinostomy. Acta Otorhinolaryngol Ital 1995;15:449-53.
  14. Acute dacryocystitis causing orbital cellulitis and abscess. Orbit 2009;28(2-3):196-99.
  15. Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology 1998;105:1106-13.
  16. Clinical bacteriology of dacryocystitis in adults. Ophthal Plast Reconstr Surg 1993;9: 125-31.
  17. Endoscopic nasal dacryocystorhinostomy: Results and advantages over external approach. Rev Bras Otorrinolaringol (Engl Ed) 2005;71(3): 356-60.
  18. Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol 2000;109:430-35.
  19. Dacryocystorhinostomy failure association with nasolacrimal silicone intubation. Ophthalmic Surg 1982;20:486-89.
  20. The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surg 1994;24:597-600.
  21. Role of endoscopic dacryocystorhinostomy in treating acquired lacrimal fistulae. J Laryngol Otol 2003 Oct;117(10):793-95.
  22. Experience with bicanalicular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinostomy. J Craniomaxillofac Surg 2003;31:187-90.
  23. Results of dacryocystorhinostomy. Ophthalmic Surg 1980;11:427-30.
  24. Probes for intubation in lacrimal drainage. Ophthalmol Plas Reconstr Surg 1970;74:431-33.
  25. Lacrimal disorders, diagnosis and treatment. St Louis: CV Mosby Co 1976:130-31.
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