Endoscopic and radiological evidence refuting intra-abscess septae

Abstract

ABSTRACT Purpose To investigate the presence of septae within the lacrimal abscess and to explore simple aspiration as an alternative to the traditional management by incision and drainage. Methods Prospective, interventional pilot study involved eight lacrimal sac abscesses of eight patients over a period of three months. All patients underwent a pre-operative MRI with surface coils followed by aspiration of the abscess (n = 4) or incision and drainage of the abscess (n = 4). An intra-sac endoscopic evaluation was performed during the abscess drainage. Primary outcome measures – presence or absence of septae on MRI scan images and endoscopic evaluation of the abscess cavity. Secondary outcome measures – relief from pain and symptoms following aspiration and anatomical patency following definitive management. Results Eight patients underwent either aspiration (n = 4) or incision and drainage of the abscess (n = 4). Mean age of the patients 43.3 years and male to female ratio was 1:1. Left eye involvement was more common (Right: left = 1:3). Average duration of acute symptoms − 3.75 days. High resolution MRI showed a well- defined abscess cavity with few undulations which on endoscopic evaluation correlated with oedematous mucosal folds. There was absence of a loculi or septae within the abscess cavity. Definitive surgery in the form of endoscopic DCR was performed for all the patients with post-operative FICI grading was +5. Conclusion The present study refutes the presence of septae within the abscess cavity and proposes aspiration of the lacrimal sac abscess as a minimally invasive procedure with minimal logistics and a shallow learning curve.