title: Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?
abstract: To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE).
  
  
  
  Case series with chart review.
  
  
  
  Academic tertiary center.
  
  
  
  The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013.
  
  
  
  The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported.
  
  
  
  The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery.
  
  
  
  Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field.
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy davinter@libero.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Lombardi
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Mattavelli
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy.
authors.forename: Remo
authors.initials: R
authors.lastname: Accorona
authors.affiliation: Department of Ophthalmology, University of Brescia, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Turano
authors.affiliation: Department of Ophthalmology, University of Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Bozzola
authors.affiliation: Department of Otorhinolaryngology, University of Brescia, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003607:Dacryocystitis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003608:Dacryocystorhinostomy; D004653:Empyema / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct; D018579:Patient Selection; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: acute dacryocystitis; endoscopic dacryocystorhinostomy; lacrimal sac empyema