A CLINICAL STUDY ON ROLE OF ENDONASAL DACRYOCYSTORHINOSTOMY IN THE TREATMENT OF ACUTE DACRYOCYSTITIS AND ITS OUTCOME

BACKGROUND \nInflammation of the lacrimal sac is called as dacryocystitis. It is of two types- acute and chronic. It can present in congenital or \nadult age group. People in their fifth decade and in old age are frequently affected. Congenital dacryocystitis affects both sexes \nequally. In adults, females are more commonly affected than males. Treatment of acute dacryocystitis is essentially surgical. \nHowever, prior to surgical approach, broad spectrum systemic antibiotic therapy is useful in sub-acute and acute dacryocystitis \nfollowed by dacryocystorhinostomy. We wanted to determine the role of the Endonasal dacryocystorhinostomy in the treatment \nof acute dacryocystitis and to assess the success rate of the procedure. \nMETHODS \n33 patients attending the Department of Ophthalmology, GMC, OGE, Chennai, were evaluated in detail. Out of 33, three patients \ndidn’t turn up for surgery. 30 cases of acute dacryocystitis with abscess with established nasolacrimal duct obstruction \nunderwent endonasal DCR surgery under local anaesthesia. On the first post-operative day on the basis of verbal pain and \noedema score, post-operative comfort level was assessed. At each visit, anatomical patency of the nasolacrimal duct and \nsymptomatic relief of patient were assessed. \nRESULTS \nIn this study, out of 30 patients, 26 were females, 4 were males. All the patients who underwent endonasal DCR were examined \nwith nasolacrimal duct syringing on the first postoperative day and at the end of first week. In our study, two patients presented \nwith simple regurgitation through opposite punctum. They were treated with meticulous antibiotic and steroid syringing on \nalternate days. Their ducts became patent by the end of first week. At the end of first month two patients were found to have \nblocked ducts. So, the success rate of this procedure at the end of the first month was around 93.3%. The two patients with \nblocked ducts were taken up for diagnostic revision endonasal DCR and the mucosal flaps and the closure of the ostium were \nrevised. 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 \npatient did not come for follow up and two patients had blocked ducts. The success rate of this study is around 90% at the end \nof six months. Out of 30 patients 19 patients had no pain and oedema, 9 patients suffered from mild pain and oedema, 2 \npatients had moderate pain and oedema. In this study, it was found that most of the patients were symptom free in the \npostoperative period. Two patients with intra operative bleeding were managed by applying pressure and packing cotton \npledgets soaked with vasoconstrictive agents like adrenaline. One patient suffered from epistaxis and was managed with \nadrenaline nasal packs. Patients who presented with late closure of the ostium were subjected to revision surgery after releasing \nthe adhesions. \nCONCLUSIONS \nExternal dacryocystorhinostomy is contraindicated in acute dacryocystitis. If acute dacryocystitis is left untreated, it may lead \nto lacrimal fistula. These complications can be avoided by timely intervention by endonasal dacryocystorhinostomy. Endonasal \ndacryocystorhinostomy is associated with less intraoperative and early post-operative complications. It is cosmetically well \naccepted. In spite of expert surgical skills, steep learning curve and expert instrumentation are required for this procedure. \n