title: Acquired fistula of the lacrimal sac and laisser-faire approach. Description of the natural history of acquired fistulas between the lacrimal sac and the skin occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula.
abstract: BACKGROUND
  The formation of a fistula between the lacrimal sac and the skin is a classic outcome of resistant lacrimal sac abscesses. There is currently no consensus about treatment in such cases. The goal of this study was to describe the natural history of acquired fistulas between the lacrimal sac and the skin, occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula.
  
  
  METHODS
  This prospective study was only descriptive and included patients between 1999 and 2012. The patients included were adults with a nasolacrimal duct (NLD) obstruction that was planned to be treated with endonasal DCR. A resistant lacrimal sac abscess appeared a few days before the planned surgery, and fistulized spontaneously despite medical treatment. The surgery was not delayed. The DCR was endoscopic. Nothing was done for the fistula. Its healing was spontaneous. The exclusion criteria were the following: congenital fistulas, post-traumatic and/or iatrogenic fistulas, fistulas which had regressed by the day of the surgery, postoperative follow-up less than 5 months, post-traumatic and/or iatrogenic fistulas, any history of previous DCR or any other lacrimal surgery, children.
  
  
  RESULTS
  Twenty adults (25 cases) were included in the analysis. Mean age was 79 years old (from 41 to 90). The mean follow-up was 41 months (from 5 to 108 months). The fistula spontaneously disappeared in all cases, less than one month after it had appeared and in a permanent fashion. No unsightly scar developed.
  
  
  CONCLUSIONS
  Spontaneously acquired fistulas between the lacrimal sac and the skin may occur in the natural course of abscessed acute dacryocystitis. Our study showed spontaneous healing of the fistula post-endoscopic DCR.
  
  
  CONCLUSIONS
  Fistula excision in fistulous acute dacryocystitis does not seem essential to its healing. The laisser-faire approach appears adequate for aesthetic outcomes as well as for functional outcomes of DCR.
authors: Hôpital Hôtel-Dieu, 1, parvis Notre-Dame - place Jean-Paul-II, 75004 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: Aurelie.pison@gmail.com.
authors: A
authors: A
authors: Pison
authors: Cabinet privé, 30, place Carriere, 54000 Nancy, France.
authors: J-L
authors: JL
authors: Fau
authors: Cabinet privé, 19, rue Oudinot, 75007 Paris, France.
authors: E
authors: E
authors: Racy
authors: Hôpital Hôtel-Dieu, 1, parvis Notre-Dame - place Jean-Paul-II, 75004 Paris, France.
authors: B
authors: B
authors: Fayet
mesh_terms: D000038:Abscess / Q000150:complications / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017577:Cutaneous Fistula / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D003607:Dacryocystitis / Q000150:complications / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000534:rehabilitation; D018450:Disease Progression; D015818:Eye Infections, Bacterial / Q000150:complications / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery; D012189:Retrospective Studies; D057832:Watchful Waiting
keywords: Acquired fistula; Cicatrice; Dacryocystite; Dacryocystitis; Dacryocystorhinostomie; Endonasal dacryocystorhinostomy; Fistule acquise; Lacrimal sac abscess; Sac lacrymal; Scar