Backup surgical solutions in recurrent chronic dacryocystitis

Abstract

Introduction. The functional purpose of the lacrimal ex­cre­tory system is to drain tears from the eyes into the na­sal cavity. The stagnation of tears in the lacrimal sac in the conditions of a stenotic drainage system leads to the ap­pearance of acute and chronic dacryocystitis. Chronic da­cryo­cystitis, with frequent episodes of exacerbation, is ex­tremely torturous for the patient and, after 1-2 years of evolution, it requires a definitive radical solution. Thus, oph­thal­mo­logists and ENT surgeons must find solutions for patients with multiple interventional procedures in the lacrimal nasal passages. Materials and method. We conducted a retrospective clinical study on 27 pa­tients (29 eyes) hospitalized in the ENT Department of the Bucharest University Emergency Hospital between 2014 and 2018. The inclusion criteria were: chronic da­cryo­cystitis with nasolacrimal stenosis, with at least one failed conservative therapeutic procedure. The exclusion criteria were: presacal stenosis of the tear ducts, patients without conservative therapeutic procedures (stent/en­do­sco­pic dacryocystorhinostomy – DCRS). The clinical pro­to­col consisted of ophthalmological examination, ENT examination, contrastography, nasal endoscopy, cranio­cerebral CT, and surgery in a mixed ophthalmologist-ENT team. Post-therapeutic monitoring was performed at 1, 2 and 6 months. Results. The therapeutic procedures consisted of stents under nasal endoscopic control in 38% of cases, external DCRS in 21% of cases, and dacryocystectomy in 41% of cases. In stented cases (11 cases) there were two failures (which were resolved one by DCRS, and the other by dacryocystectomy). In cases where external DCRS was performed (6 cases), we had no failure, and in cases with dacryocystectomy, there was one case with failure that required two reinterventions. Conclusions. External DCRS may be a therapeutic option for patients with sacal and postsacal lacrimal stenosis who have a history of curative procedure. Dacryocystectomy is the backup sur­ge­ry for recurrent chronic dacryocystitis. We consider that this intervention has minor consequences on the pa­tient’s quality of life and should be taken into account when compared to iterative conservative interventions.