Dr. Devi Govindarajan,
BACKGROUND Inflammation of the lacrimal sac is called as dacryocystitis. It is of two types- acute and chronic. It can present in congenital or adult age group. People in their fifth decade and in old age are frequently affected. Congenital dacryocystitis affects both sexes equally. In adults, females are more commonly affected than males. Treatment of acute dacryocystitis is essentially surgical. However, prior to surgical approach, broad spectrum systemic antibiotic therapy is useful in sub-acute and acute dacryocystitis followed by dacryocystorhinostomy. We wanted to determine the role of the Endonasal dacryocystorhinostomy in the treatment of acute dacryocystitis and to assess the success rate of the procedure. METHODS 33 patients attending the Department of Ophthalmology, GMC, OGE, Chennai, were evaluated in detail. Out of 33, three patients didn’t turn up for surgery. 30 cases of acute dacryocystitis with abscess with established nasolacrimal duct obstruction underwent endonasal DCR surgery under local anaesthesia. On the first post-operative day on the basis of verbal pain and oedema score, post-operative comfort level was assessed. At each visit, anatomical patency of the nasolacrimal duct and symptomatic relief of patient were assessed. RESULTS In this study, out of 30 patients, 26 were females, 4 were males. All the patients who underwent endonasal DCR were examined with nasolacrimal duct syringing on the first postoperative day and at the end of first week. In our study, two patients presented with simple regurgitation through opposite punctum. They were treated with meticulous antibiotic and steroid syringing on alternate days. Their ducts became patent by the end of first week. At the end of first month two patients were found to have blocked ducts. So, the success rate of this procedure at the end of the first month was around 93.3%. The two patients with blocked ducts were taken up for diagnostic revision endonasal DCR and the mucosal flaps and the closure of the ostium were revised. At the end of third month, one patient was lost for follow up and one had blocked duct. At the end of six months one patient did not come for follow up and two patients had blocked ducts. The success rate of this study is around 90% at the end of six months. Out of 30 patients 19 patients had no pain and oedema, 9 patients suffered from mild pain and oedema, 2 patients had moderate pain and oedema. In this study, it was found that most of the patients were symptom free in the postoperative period. Two patients with intra operative bleeding were managed by applying pressure and packing cotton pledgets soaked with vasoconstrictive agents like adrenaline. One patient suffered from epistaxis and was managed with adrenaline nasal packs. Patients who presented with late closure of the ostium were subjected to revision surgery after releasing the adhesions. CONCLUSIONS External dacryocystorhinostomy is contraindicated in acute dacryocystitis. If acute dacryocystitis is left untreated, it may lead to lacrimal fistula. These complications can be avoided by timely intervention by endonasal dacryocystorhinostomy. Endonasal dacryocystorhinostomy is associated with less intraoperative and early post-operative complications. It is cosmetically well accepted. In spite of expert surgical skills, steep learning curve and expert instrumentation are required for this procedure.
