Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

Lombardi, Davide; Mattavelli, Davide; Accorona, Remo; Turano, R; Semeraro, Francesco; Bozzola, Anna; Nicolai, Piero

doi:10.1177/0194599814527236

Cited by 18 publications

(16 citation statements)

References 24 publications

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“…2,6,7 Over the past decade, primary EnDCR for the treatment of AD has been reported as a safe procedure with reasonable outcomes. [3][4][5][6][7][8][9][10][11][13][14][15][16] EnDCR allows access to the lacrimal sac through noninfected tissue plane and provides continuous drainage of the lacrimal abscess into the nasal cavity. This can prevent the spread of infection to surrounding tissues and lead to earlier resolution of the acute symptoms and infection.…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

Sung

Kim

Hwang

et al. 2021

Preprint

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Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery.Methods: A retrospective review of the medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were surgical outcomes at the final follow-up examination. The secondary outcome measure was clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days).Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery. In subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stay, and the duration of antibiotics treatment were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the 2 groups (p = 1.000)Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR, performed within 3 days, leads to faster recovery and shortens the course of antibiotic treatment.

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Section: Discussionmentioning

confidence: 99%

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

Sung

Kim

Hwang

et al. 2021

Preprint

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“…Our results show a high success rate of Crawford tube insertion for the treatment of lacrimal sac abscess with all patients demonstrating a significant improvement in signs and symptoms. Simple incision and drainage without intubation has shown a success rate of 91.7–96.2% in several studies with a follow-up of more than two years [4, 13]. However the patients accepted simple incision and drainage may need further external or endonasal DCR to manage the epiphora.…”

Section: Discussionmentioning

confidence: 99%

Management lacrimal sac abscesses using lacrimal probe and crawford silicon tube

Lin

Jin

et al. 2016

BMC Ophthalmol

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BackgroundTreatment of lacrimal sac abscess of the traditional surgical approach may result in complications from cutaneous fistula formation, damage the sac, cause skin scarring and even have the potential for inducing cicatricial ectropion. We designed a new treatment scheme that is expected to achieve internal drainage with the use of lacrimal probe and crawford silicon tube.MethodsA prospective study was performed for the management of lacrimal sac abscesses. All suitable patients from January 2011 to June 2014 were managed by lacrimal probe and crawford tube insertion. Postoperatively, patients received 0.5% Levofloxacin eye drops four times per day and oral Levofloxacin tablets 0.5 g once per day for four days. Follow-up times were for more than three months after removing the Crawford tube. The condition of the lacrimal sac and the patient’s symptoms were carefully evaluated.ResultsFourteen patients suffering from lacrimal sac abscesses were included in this study. A history of chronic dacryocystitis was found in six patients, after acute dacryocystitis was found in three patients, and nasolacrimal occlusion with epiphora was found in other five patients. Resolution of signs and symptoms of lacrimal sac abscesses in all fourteen patients. No recurrence of lacrimal sac abscesses occurred during the median follow up period of 20.9 ± 7.8 months (range 6–36 months). Epiphora reoccurred in four patients.ConclusionsLacrimal probe and crawford silicon tube is successful as a procedure of choice for lacrimal sac abscesses. The insertion of a Crawford tube also offers potential advantages over standard treatment with the lack of recurrence of dacryocystitis or infection in post-surgical patients.

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“… After application of mucosal flaps, the neo-ostium shrinks during the first 4 weeks by 20–25% and remains stable for the next 12 months [ 964 ]. Important surgery determinants for the success of the intervention are the creation of big fenestrations and the use of mucosal flaps to cover bare bone edge-to-edge [ 274 ], [ 965 ], [ 966 ], [ 967 ], [ 968 ], [ 969 ], [ 970 ], [ 971 ]. Furthermore the necessity of local postoperative care is reduced in DCR performed with mucosal flaps [ 965 ].…”

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

“…Important surgery determinants for the success of the intervention are the creation of big fenestrations and the use of mucosal flaps to cover bare bone edge-to-edge [ 274 ], [ 965 ], [ 966 ], [ 967 ], [ 968 ], [ 969 ], [ 970 ], [ 971 ].…”

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

“…Endonasal endoscopic DCR as immediate therapy in case of acute dacryocystitis with empyema of the lacrimal sac avoids the risk of cutaneous fistula and is expected to minimize the risk of orbital complications. It achieves a high success rate of up to 96.5% [ 971 ], [ 982 ]. Even in children the results of endonasal DCR are comparably good with a success rate of about 90% compared to external DCR [ 983 ].…”

Section: Indications Of Surgery Beyond Chronic Rhinosinusitismentioning

confidence: 99%

See 1 more Smart Citation

Comprehensive review on endonasal endoscopic sinus surgery

Weber¹,

Hosemann

2015

GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery; 14:Doc08

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Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

Cited by 18 publications

References 24 publications

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

Management lacrimal sac abscesses using lacrimal probe and crawford silicon tube

Comprehensive review on endonasal endoscopic sinus surgery

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