Primary treatment of acute dacryocystitis by endoscopic dacryocystorhinostomy with silicone intubation guided by a soft probe.
OBJECTIVE
To investigate the suitability of cold steel endonasal endoscopic dacryocystorhinostomy (EES-DCR) with circular bicanalicular intubation with silicone tubes (CBIST) guided by a soft probe for the primary treatment of acute purulent dacryocystitis (APD).


METHODS
Prospective, randomized, interventional case series.


METHODS
Seventy-two patients (59 females, 13 males) with a median presenting age of 55+/-12 years (range, 28-71 years).


METHODS
Eighty-four patients with unilateral APD were equally and randomly divided into 2 groups. Cold steel EES-DCR was performed after the lacrimal abscess formation, and external dacryocystorhinostomy (E-DCR) was performed 1 to 2 weeks after resolution of the acute inflammation. In both groups, CBIST guided by a soft probe was performed and the silicone tubes were kept in the lacrimal passages for 3 months. Postoperative follow-up ranged from 12 to 24 months. Outcomes were compared between both groups, considering resolution time for external acute inflammation, success rate of free lacrimal passage reconstruction, and lack of complications as indicators of treatment suitability.


METHODS
Time for resolution of the external acute inflammation, success rate of free lacrimal passage reconstruction, and complications.


RESULTS
In this study, complete postoperative data were acquired from 40 patients in the EES-DCR group and from 32 patients in the E-DCR group, and the outcomes were compared. Acute inflammation resolved more quickly in the EES-DCR group than in the E-DCR group (P<0.05). Ostium patency at 12 months after silicone tube removal was achieved in significantly more patients in the EES-DCR group (36/40 [90%]) than in the E-DCR group (21/32 [65.7%]; P<0.01). In the EES-DCR group, lacrimal passage reconstruction failed because of intranasal ostial closure in 3 patients and because of common canaliculus obstruction in 1 patient. In the E-DCR group, lacrimal passage reconstruction failed because of intranasal ostial closure in 3 patients, lacrimal sac fibrosis, granulation, or both in 6 patients, and common canaliculus obstruction in 2 patients. Other than the slight laceration of the inferior puncta, no significant complications arose from the treatments.


CONCLUSIONS
Cold steel EES-DCR with CBIST guided by a soft probe is a promising alternative for the primary treatment of APD with abscess formation.


BACKGROUND
The authors have no proprietary or commercial interest in any materials discussed in this article.
Wu
Wencan
W
Eye Hospital of Wenzhou Medical College, Wenzhou, Peoples' Republic of China. wuwencan118@163.com
Yan
Wentao
W
MacCallum
Julia K
JK
Tu
Yunhai
Y
Jiang
Alice C
AC
Yang
Yuan
Y
Xiao
Tianlin
T
Li
Jin
J
Wang
Qinmei
Q
Qu
Jia
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003607:Dacryocystitis / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000379:methods*; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007440:Intubation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery*; D011182:Postoperative Care; D011446:Prospective Studies; D012828:Silicones
D012828:Silicones