Skip to main content

Endonasal DCR with Silicon Tube Stents: A Better Management for Acute Lacrimal Abscesses

Indian Journal of Otolaryngology and Head & Neck Surgery volume 65, pages 343–349 (2013)Cite this article

Abstract

Acute dacryocystitis, or inflammation of the lacrimal sac with lacrimal abscess, is almost always secondary to nasolacrimal duct obstruction. The standard practice for the treatment is incision and drainage because of concerns about the risks of exacerbation and spread of infection. Here we tried to evaluate primary EnDCR as a treatment for acute dacryocystitis with abscess formation. Department of ENT, Head and Neck Surgery, KVG Medical College, Sullia. This is comparative case series analysis study done in our medical college hospital during the study period 61 months from January 2007 to November 2011. 31 cases of acute dacryocystitis with lacrimal abscess managed were included in the study. 13 cases were operated primarily with EnDCR. Rest of the 18 cases was managed conventionally by incision and drainage and later by an external approach of DCR. Swelling disappeared intraoperatively in all EnDCR cases while medial canthal edema and erythema completely reduced within 2–3 days post-operatively. While in incision and drainage swelling disappeared partially intraoperatively and repeated draining was needed on the 2nd and 3rd day. The mean VAS score on first post operative day was 3.14 in group A and was 4.64 in group B. Group A had faster pain relief with 92.3% 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. 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 abscesses.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Graph 1

References

  1. Nerad JA, Kersten RC, Neuhaus RW et al (1998) Basic and clinical science course: orbit, eyelids, and lacrimal system. American Academy of Ophthalmology, San Francisco, pp 1–269

    Google Scholar 

  2. Cahill KV, Burns JA (1993) Management of acute dacryocystitis in adults. Ophthal Plast Reconstr Surg 9:38–41

    PubMed  Article  CAS  Google Scholar 

  3. Chaudhary M, Bhattarai A, Adhikari SK, Bhatta DR (2010) Bacteriology and antimicrobial susceptibility of adult chronic dacryocystitis. Nepal J Ophthalmol 2(4):105–113

    PubMed  CAS  Google Scholar 

  4. Massaro BM, Gonnering RS, Harris GJ (1990) Endonasal laser dacryocysto-rhinostomy. A new approach to nasolacrimal duct obstruction. Arch Ophthalmol 108:1172–1176

    PubMed  Article  CAS  Google Scholar 

  5. Lee TS, Woog JJ (2001) Endonasal dacryocystorhinostomy in the primary treatment of acute dacryocystitis with abscess formation. Ophthal Plast Reconstr Surg 17:180–183

    PubMed  Article  CAS  Google Scholar 

  6. Duggal P, Mahindroo NK, Chauhan A (2008) Primary endoscopic dacryocysto-rhinostomy as treatment for acute dacryocystitis with abscess formation. Am J Otolaryngol 29:177–179

    PubMed  Article  Google Scholar 

  7. Wu Wencan, Yan Wentao, MacCallum JK, Tu Yunhai, Jiang Alice C et al (2009) Primary treatment of acute dacryocystitis by endoscopic dacryocysto-rhinostomy with silicone intubation guided by a soft probe. Ophthalmology 116(1):116–122

    PubMed  Article  Google Scholar 

  8. Morgan S, Austin M, Whittet H (2004) The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy. Br J Ophthalmol 88:139–141

    PubMed  Article  CAS  Google Scholar 

  9. Presutti L (1995) Endonasal dacryocystorhinostomy. Acta Otorhinolaryngol Ital 15:449–453

    PubMed  CAS  Google Scholar 

  10. Hartikainen J, Grenman R, Puukka P, Seppa H (1998) Prospective randomized comparison of external dacryocystorhinostomy and endonasal laser dacryocystorhinostomy. Ophthalmology 105:1106–1113

    PubMed  Article  CAS  Google Scholar 

  11. Maheshwari R, Maheshwari S, Shah T (2009) Acute dacryocystitis causing orbital cellulitis and abscess. Orbit 28(2–3):196–199

    PubMed  Article  Google Scholar 

  12. Babar TF, Masud MZ, Saeed N, Khan MD (2003) An analysis of patients with chronic dacryocystitis. Pak J Ophthalmol 19(3):77–83

    Google Scholar 

  13. Mandal R, Banerjee AR, Biswas MC, Mondal A, Kundu PK, Sasmal NK (2008) Clinicobacteriological study of chronic dacryocystitis in adults. J Indian Med Assoc 106(5):296–298

    PubMed  Google Scholar 

  14. Dalgleish R (1967) Idiopathic acquired lacrimal drainage obstruction. Br J Ophthalmol 51(7):463–468

    PubMed  Article  CAS  Google Scholar 

  15. Bharathi MJ, Ramakrishnan R, Maneksha V, Shivakumar C, Nithya V, Mittal S (2008) Comparitive bacteriology of acute and chronic dacryocystitis. Eye 22(7):253–260

    Article  Google Scholar 

  16. Coden DJ, Hornblass A, Haas BD (1993) Clinical bacteriology of dacryocystitis in adults. Ophthal Plast Reconstr Surg 9:125–131

    PubMed  Article  CAS  Google Scholar 

  17. Kupper DS, Demarco RC, Resende R et al (2005) Endoscopic nasal dacryocystorhinostomy: results and advantages over external approach. Rev Bras Otorrinolaringol (Engl Ed) 71(3):356–360

    Article  Google Scholar 

  18. El-Guindy A, Dorgham A, Ghoraba M (2000) Endoscopic revision surgery for recurrent epiphora occurring after external dacryocystorhinostomy. Ann Otol Rhinol Laryngol 109:430–435

    Google Scholar 

  19. Woog JJ, Metson R, Puliafito CA (1993) Holmium YAG endonasal laser dacryocysto-rhinostomy. Am J Ophthalmol 116:1–10

    PubMed  CAS  Google Scholar 

  20. Allen KM, Berlin AJ (1982) Dacryocystorhinostomy failure association with nasolacrimal silicone intubation. Ophthalmic Surg 20:486–489

    Google Scholar 

  21. Walland MJ, Rose G (1994) The effect of silicone intubation on failure and infection rates after dacryocystorhinostomy. Ophthalmic Surg 24:597–600

    Google Scholar 

  22. Subbaiah S (2003) Role of endoscopic dacryocystorhinostomy in treating acquired lacrimal fistulae. J Laryngol Otol 117(10):793–795

    PubMed  Article  Google Scholar 

  23. Sodhi PK, Pandey RM, Malik KP (2003) Experience with bicanalicular intubation of the lacrimal drainage apparatus combined with conventional external dacryocystorhinostomy. J Craniomaxillofac Surg 31:187–190

    PubMed  Article  Google Scholar 

  24. Lavhlan Mc, Sahannon GM, Flanagan JC (1980) Results of dacryocysto-rhinostomy. Ophthalmic Surg 11:427–430

    Google Scholar 

  25. Quickert Mh, Dryden RM (1970) Probes for intubation in lacrimal drainage. Ophthalmol Plast Reconstr Surg 74:431–433

    CAS  Google Scholar 

  26. Veirs ER (1976) Lacrimal disorders—diagnosis and treatment. CV Mosby Co, St. Louis, pp 130–131

    Google Scholar 

Download references

Author information

Affiliations

  1. Department of ENT, Head and Neck Surgery, KVG Medical College Hospital, Kurunjibag, Sullia, D.K. Karnataka, 574327, India

    Sudhir M. Naik, Mohan K. Appaji, S. Ravishankara & Annapurna S. Mushannavar

  2. Department of Anaesthesia, Narayana Hrudayalaya, Bangalore, India

    Sarika S. Naik

Authors
  1. Sudhir M. Naik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohan K. Appaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Ravishankara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annapurna S. Mushannavar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarika S. Naik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sudhir M. Naik.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Naik, S.M., Appaji, M.K., Ravishankara, S. et al. Endonasal DCR with Silicon Tube Stents: A Better Management for Acute Lacrimal Abscesses. Indian J Otolaryngol Head Neck Surg 65, 343–349 (2013). https://doi.org/10.1007/s12070-012-0507-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-012-0507-8

Keywords

  • Endoscopic dacryocystorhinostomy (EnDCR)
  • Dacryocystitis
  • Lacrimal abscess
  • Incision and drainage