Acute Dacryocystitis with Abscess: Endonasal Dacryocystorhinostomy, the Primary Treatment of Choice

Background/objectives: Acute dacryocystitis, or inflammation of the lacrimal sac with abscess, is almost always secondary to nasolacrimal duct obstruction. The standard practice for treatment is incision and drainage because of concerns about the risks of exacerbation and spread of infection. Here, we tried to evaluate primary endoscopic dacryocystorhinostomy (EnDCR) as a treatment for acute dacryocystitis with abscess formation. Materials and methods: This is comparative case series analysis study done during the study period of 54 months from January 2007 to May 2011. A total of 46 cases of acute dacryocystitis with lacrimal abscess managed were included in the study. Twenty-one cases were operated primarily with EnDCR. Rest of the 25 cases was managed conventionally by incision and drainage and later by an external DCR. Results: Swelling disappeared intraoperatively in all EnDCR cases while medial canthal edema and erythema completely reduced within 2 to 3 days postoperatively. While in incision and drainage swelling disappeared partially intraoperatively and repeated draining was needed on the 2nd and 3rd day. The mean visual analog scale (VAS) score on first postoperative day was 3.14 in group A and was 4.64 in group B. Group A had faster pain relief with 95.23% 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. Conclusion: 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 abscess.