Outcomes Of Dacryocystorhinostomy Research Articles

Surgical Outcome of Dacrystorhinostomy in Fistulous Dacryocystitis

Purpose: To study the surgical outcomes of Dacryocystorhinostomy (DCR) in fistulous dacryocystitis.
 Study Design: Quasi Experimental study.
 Place and Duration of Study: The detailed study was carried out in the Institute of Ophthalmology, Liaquat University Hospital Jamshoro, between September 2018 to August 2020.
 Material and Methods: We analyzed the histories of 30 patients taking the DCR procedure and noted their mean age, standard deviation, follow-up time, complications and other details. We also reported the intraoperative anatomical results, postoperative analysis, and variable groups vs. outcomes post-surgery using SPSS Version 20.
 Results: The mean patient's age was 44.2 ± 4.13years, where males to female percentages were 27% to 73%. We noted significant changes in patients with a success rate of 87% displayed by no relieved epiphora and lacrimal patency in 1 month, 3 months, and 6 months. The mean time of the patients was 4 months varying between 1 to 8 (months) and the variable group values vs. surgical outcomes showed no significant association between the variables (p-value ranging from 0.195 to 0.935).
 Conclusion: Complications resulting in some patient’s post-surgery are manageable and the surgical technique has a good success rate.
 Key Words: (DCR) Dacryocystorhinostomy, lacrimal Patency, fistulous Dacryocystitis, Scarring.

Comparative evaluation of dacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy

ObjectiveTo compare the surgical outcomes of dacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy for the management of proximal mid-bicanalicular lacrimal obstruction. DesignRandomized, controlled trial. MethodsThe study was conducted in 50 eyes of 50 adult patients with bicanalicular obstruction ≤ 6 mm from the punctum. The etiology, duration of symptoms, and Munk scores were recorded. Group A underwent dacryocystorhinostomy with retrograde intubation, and in group B, conjunctivo-dacryocystorhinostomy was performed. Success was defined as anatomic patency on syringing, a negative fluorescein dye disappearance test, and a Munk score < 2 twelve months postoperatively. ResultsThere were 23 males and 27 females, 18–66 years of age, with a 6-month to 20-year duration of epiphora. The etiologies were idiopathic, trauma, and allergic conjunctivitis and ocular surface inflammation. In group A, the pseudopunctum was located medial to the diagnosed level of canalicular block by 1.28 ± 0.54 mm and 1.04 ± 0.88 mm in upper and lower canaliculi, respectively. Four post-traumatic cases required intervention following closure of the pseudopunctum, all being located ≥ 7 mm from the true punctum (p = 0.001). The complication rate was higher in group B than in group A (p = 0.001). At 12 months, the success rate was 100% in group A and 88% in group B (22 of 25; p = 0.74), with reduction in Munk scores from preoperative levels in both groups (p = 0.001). ConclusionDacryocystorhinostomy with retrograde intubation and conjunctivo-dacryocystorhinostomy have comparable success rates in the management of proximal mid-bicanalicular obstructions. Dacryocystorhinostomy with retrograde intubation has lower complication rates and does not require long-term maintenance of the bypass tube, unlike conjunctivo-dacryocystorhinostomy.

In Vivo Morphological Study of Common Canalicular Orifice and Its Impact on Lacrimal Probing.

To study the in vivo morphology of common canalicular/lacrimal sac mucosal folds (CLS-MFs) and their relationship with probing findings. Consecutive cases undergoing endoscopic dacryocystorhinostomy had endoscopic examination of the internal canalicular orifice (ICO). Details of CLS-MFs folds, probing findings, and outcomes of dacryocystorhinostomy were analyzed. Thirty-six lacrimal systems of 34 patients (mean age, 58 years; 7 males, 27 females) were examined. All 36 lacrimal systems had a single common canalicular orifice entering the lacrimal sac (100%). Overall, 61.1% (22/36) had visible CLS-MFs, out of which only 13.6% (3/22) were overhanging the ICO requiring manipulation of the probe to enter the lacrimal sac. The orientation of folds was superior 180° in 2, posterosuperior in 2, posterior in 6, inferior 180° in 6, and inferior 270° (excluding 10-2'o clock quadrant) in 6 systems. Two cases preoperatively labeled as having common canalicular obstruction, based on lacrimal syringing, had CLS-MFs impacting against the ICO without any anatomical obstruction. One of 5 cases with lacrimal sac mucocele had CLS-MFs located along the posterosuperior edge extending for 270°, which resulted in a soft stop on preoperative lacrimal syringing findings. Only 1 case had a true membrane (2.7%) overlying the ICO, which required excision. No differences in outcomes of dacryocystorhinostomy were observed between cases with CLS-MFs versus without any folds. CLS-MFs display a wide variation in terms of morphological location and extent along the ICO. They might be responsible for the false soft stop observed in some cases on preoperative syringing and do not require excision.

Outcomes of dacryocystorhinostomy (DCR) in failure cases of probing of congenital nasal duct obstruction

Outcomes of external dacryocystorhinostomy (DCR) in failure cases of probing of congenital naso-lacrimal duct obstruction (CNLDO) is very successful. External DCR is indicated in failure cases of probing. Probing is modality of choice in CNLDO below one year.

The nasal mucosa and outcomes of dacryocystorhinostomy

To investigate the impact of the nasal mucosa on the outcomes of dacryocystorhinostomy on the basis of morphologic findings. The investigation enrolled 73 patients who had undergone endonasal endoscopic dacryocystorhinostomy. Nasal mucosal biopsies were intraoperatively taken from all the patients. The obtained samples were subjected to standard histological examination, as well as to immunohistochemical study using an anti-alpha-smooth muscle actin antibody. To determine the intensity of inflammation in the tissue sample, a chronic inflammation score was calculated. The cell elements positively stained with α-smooth muscle actin were estimated using a semi-automatic method. The patients were divided into groups in accordance with the outcome of surgical treatment after 6 months. An unfavorable outcome of dacryocystorhinostomy was observed in 10 (13.7%) patients. The samples obtained from the patients showed a higher chronic inflammation score (8.33%) and a larger number of the cell elements positively stained with α-smooth muscle actin (6026.38±1944.29). The correlation between the outcome of surgical intervention and the quantitative characteristics of myofibroblasts was statistically significant (p<0.05). These studies suggest that there is a direct correlation of the efficiency of endonasal endoscopic dacryocystorhinostomy with the presence and degree of chronic nasal mucosal inflammation at baseline.

Influence of fibrosis mediators on the outcomes of endoscopic endonasal dacryocystorhinostomy

Fibrosis is the most important pathologic condition involved in undesirable outcomes of dacryocystorhinostomy. A number of biochemical factors are currently known to have an effect on wound healing by promoting excessive scarring. Isoforms of transforming growth factor β (TGF-β1) are considered the 'main' pro-fibrotic factor, but wound healing is also affected by other cytokines such as connective tissue growth factor (CTGF), which stimulates fibrosis, and fibroblast growth factor (FGF-2), which acts as antagonist to it. To investigate correlations between endoscopic endonasal dacryocystorhinostomy outcomes and certain mediators of fibrosis. The study included 45 cases of endoscopic endonasal dacryocystorhinostomy. The patients were grouped according to surgery outcome: patients with unsuccessful surgical treatment were assigned to group 1 (n=10); patients with successful surgical treatment - to group 2 (n=34). One patient was excluded from the study. Full-layer biopsy specimen were taken from patients' nasal mucosa before the surgery. TGF-β1, TGF-β2, TGF-β3, CTGF, FGF-2 concentrations were evaluated using ELISA and normalized by total protein concentration. Surgical failure was observed in 10 cases (22.72%). CTGF concentration was significantly correlated with negative outcome (p<0.05) and was elevated in most specimen obtained from group 1. No significant correlation was noted between the concentrations of other evaluated cytokines in nasal mucosa specimens and the surgical outcome. The study found a correlation between CTGF concentration in nasal mucosa and dacryocystorhinostomy outcome, which supports the hypothesis suggested by several authors linking dacryocystorhinostomy failure with chronic inflammation in nasal mucosa.

Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy

Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy

Comparison of the extrusion rate of Crawford tubes.

To compare the outcomes of dacryocystorhinostomy (DCR) using traditional Crawford tubes (TCT) and Crawford tubes with suture (CTS) in the lumen. Retrospective case series consisting of patients who underwent DCR between 2008 and 2013. A total of 61 DCRs were performed on 50 patients. Patients who underwent DCR using CTS had higher rates of prolapse compared to the TCT group (50% vs 9.4%; P=0.003). Stent removal occurred earlier in patients who received CTS (3.3mo vs 5.1mo; P=0.004). Success rates were equivalent between the two groups (75% vs 81.1%; P=0.684). CTS in the lumen increases the risk of prolapse, prompting earlier tube removal in patients following DCR for nasolacrimal duct obstruction (NLDO). Earlier removal of tubes does not appear to significantly decrease success rates.

Surgical outcome of pediatric dacryocystorhinostomy in Nepal

To report the indications and surgical outcome of dacryocystorhinostomy (DCR) in children treated at a single tertiary eye hospital in Nepal. The medical records of consecutive pediatric patients who underwent external DCR with silicon tube intubation after failed nasolacrimal irrigation and probing from January 2010 to June 2011 were retrospectively reviewed. Surgical success was defined as resolution of epiphora, normal tear film height, negative fluorescein dye disappearance test and anatomic patency determined by irrigation of the lacrimal system. The etiology of the nasolacrimal duct obstruction was acquired nasolacrimal duct obstruction (NLDO) in 63%, congenital NLDO in 23%, trauma in 1% and congenital bony abnormality in 1 patient. Of the 38 patients who completed follow-up, 37 (97%) had a successful result. External DCR effectively treated a variety of pediatric NLDO etiologies, with a low rate of complications.

Evaluation of dacryocystorhinostomy using optical coherence tomography and rebamipide ophthalmic suspension.

PurposeTo evaluate the surgical outcome of dacryocystorhinostomy (DCR) by measuring the tear meniscus, using optical coherence tomography and rebamipide ophthalmic suspension.MethodsPatients with nasolacrimal obstruction and chronic dacryocystitis who were scheduled for an endonasal DCR underwent tear meniscus examinations before and 2 months after surgery. Vertical scans of the inferior menisci were performed before and at 1, 3, 5, 7, and 10 minutes after the instillation of rebamipide ophthalmic suspension. The tear menisci areas were measured with imaging software. Ten young adults without epiphora formed the control group.ResultsAnatomical success was achieved on 22 sides of 21 patients. The patients’ postoperative tear menisci were significantly smaller than the preoperative menisci at all points during the test, and the response to volume loading in the postoperative patients was corrected to nearly that of the young, healthy adults. Nevertheless, the postoperative meniscus area tended to be larger than that of the young adults at all points.ConclusionThe reduced tear meniscus area after DCR reflected the success of the surgical procedure. However, incomplete recovery of the meniscus after the test might suggest a residual disorder of the lacrimal drainage system after DCR.

Clinical outcomes of dacryocystorhinostomy with or without intraoperative use of mitomycin C: a systematic review and meta-analysis.

To examine the possible benefit of intraoperative use of mitomycin C (MMC) application in dacryocystorhinostomy (DCR) and to assess its potential risk. Systematic review and meta-analysis of randomized-controlled trials (RCTs). A comprehensive literature search was performed according to a protocol set in advance. The participants included 811 patients of which 820 eyes were sampled for 14 RCTs. Only pertinent RCTs were identified and included in this meta-analysis. The primary efficacy measure was "patency of irrigation" at follow-up end point. The subjective outcome of "symptom relief" was also extracted as a secondary efficacy measure. For each study, relative risk was extracted. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed. RevMan version 5.0 software was used for statistical analysis. In the primary efficacy measure, the use of MMC can significantly increase the rate of "patency of irrigation" [risk ratio (RR), 1.10; 95% confidence interval (CI), 1.04-1.17; P=0.0006]; the outcome of "symptom relief" was also affected by the use of MMC (RR, 1.15; 95% CI, 1.05-1.26; P=0.003). Sensitivity analysis suggested that the result was comparatively reliable. Intraoperative use of MMC can bring about a positive effect to the outcomes of "patency of irrigation" and "symptom relief," which increases the success rate of DCR surgery.

Pattern and outcome of surgical management of nasolachrymal duct obstruction in children: a five year review.

To determine the pattern of naso-lachrymal duct obstruction (NLDO) and outcome of dacryocystorhinostomy (DCR) in children in Aminu Kano Teaching Hospital Kano, over a 5-year period. The clinic and theater registers were used to retrieve the records of all patients below the age of 15 years who presented with NLDO. The information obtained included age, sex, duration, and types of clinical signs at presentation cause of obstruction and outcome of DCR. Successful outcome is defined as patent naso-lachrymal duct 1 year after surgery. All the patients had external DCR with stent inserted into the lachrymal sac and anchored to the columella and left in situ for 6 weeks. Fortnightly for three visits then at 2 months intervals. At each visit, the patient had lachrymal punctal cannulation and irrigation with normal saline to ensure free drainage. There were 17 patients, 9 males and 8 females (M: F = 1.1: 1). Two patients (11.8%) had bilateral disease and 15 (88.2%) were unilateral. The patients' ages ranged between 2 and 10 years. The commonest presenting features were tearing and discharge. In 14 patients (82%) tearing started from birth though patients presented much later. Congenital NLDO occurred in 82%, and in the remaining 18%, obstruction was caused by depressed nasal fracture. Fifteen patients (88%) had successful outcome of DCR at 1-year follow-up. The commonest complication noted was stent extrusion before 6 weeks in 17.6% of cases. Conclusion : NLDO was mostly of congenital origin and was characterized by delayed presentation. Patients have good outcome with external DCR.

Outcomes of Dacryocystorhinostomy in Patients With Head and Neck Cancer Treated With High-Dose Radiation Therapy

To evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck cancer treated with high-dose radiation therapy. The clinical records of 43 consecutive patients with head and neck cancer who underwent DCR after high-dose external beam radiation therapy plus ablative surgery and/or chemotherapy between December 2001 and April 2011 were retrospectively reviewed. There were 23 men and 20 women. The median age was 56 years (range, 2-92 years). Thirty-one patients were Caucasian, 6 Hispanic, 4 Asian, and 2 African American. Thirty patients (70%) presented with epiphora, 3 (7%) with dacryocystitis, and 10 (23%) with both epiphora and dacryocystitis. Symptoms were unilateral in 34 patients (79%) and bilateral in 9 patients (21%). The most common primary cancer diagnoses were squamous cell carcinoma (n = 14), sarcoma (n = 8), adenoid cystic carcinoma (n = 4), and basal cell carcinoma (n = 4). The most common primary tumor locations were the sinonasal cavity (n = 16), maxillary sinus (n = 9), palate (n = 3), and ethmoid sinus (n = 3). Thirty-seven patients (43 eyes) had DCR with silicone tube placement, and 6 patients (7 eyes) had DCR with Pyrex glass tube placement. Following DCR, 31 patients (72%) had resolution of their symptoms, and 12 patients (28%), 9 with silicone tubes and 3 with Pyrex glass tubes, had persistent or recurrent epiphora (DCR failure). The most common reason for failure was significant residual canalicular and nasal mucosal scar tissue. Eight of these 12 patients underwent additional surgery, most commonly with placement of a Pyrex glass tube. Seven (35%) of the 20 patients who underwent DCR less than 12 months after radiation therapy and 5 (21%) of the 23 patients who underwent DCR at least 12 months after radiation therapy had recurrent symptoms. Dacryocystorhinostomy in patients with head and neck cancer previously treated with high-dose radiation therapy is generally successful, especially when delayed until at least 12 months after the completion of radiation therapy. A common reason for DCR failure after high-dose radiation therapy is severe canalicular and nasal mucosal scarring.

A Systematic Review of Outcomes after Dacryocystorhinostomy in Adults

This study was designed to systematically review the clinical outcomes of dacryocystorhinostomy (DCR) surgery. Data sources included PubMed for English language literature from January 1966 to December 2008 combined with a manual review of citations within article bibliographies. Citations acquired from the targeted search were filtered independently by two researchers. Relevant articles were reviewed to obtain information including interventions and outcome measures. The surgical techniques were categorized into external DCR (EX-DCR), endonasal laser-assisted DCR (LA-DCR), and nonlaser endoscopic endonasal DCR techniques (EN-DCR). Articles were then assigned level-of-evidence grades as defined by the Oxford Center for Evidence-Based Medicine. A total of 73 studies that fulfilled the inclusion criteria were analyzed. Of these, 68 were graded as level 4, 11 were graded as level 3b, and 1 was graded at level 2b evidence. A total of 4800 patients were pooled, from which 4921 DCRs were performed. All studies reported success during the follow-up period, although the outcome measures used were not consistent in the studies. Success varied between 65 and 100% after EX-DCR compared with EN-DCR, which varied from 84 to 94%. The success rate of LA-DCR varied widely between 47 and 100%. There was low evidence base to support the use of silicone stent to improve surgical success. Most studies did not show significantly improved outcomes with an antimetabolite. The overall intra- and postoperative complication rates were 1.0 and 6%, respectively. DCR is an effective and safe method for the treatment of nasolacrimal obstruction. Meta-analysis of outcomes was not feasible because of the heterogenous patient groups and outcome measures used. Nonetheless, the literature provides considerable levels 3 and 4 evidence to support DCR surgery in adults. Outcomes after EN-DCR and EX-DCR were comparable. The failure rate for LA-DCR was higher.

Comparison of anesthetic and surgical outcomes of dacryocystorhinostomy using loco-regional versus general anesthesia.

The aim of this study was to compare anesthetic and surgical outcomes of external dacryocystorhinostomy (DCR) under loco-regional anesthesia (LA) versus general anesthesia (GA). Retrospective chart review of all patients that underwent DCR by one surgeon (IH) over the course of a ten-year period (April 1994 to March 2003). A total of 221 DCR were performed on 209 patients during the study period: 71 were done under LA (72.0 ± 13.3 years) and 150 under GA (64.2 ± 13.0 years; P<0.001). LA patients had a shorter length of surgery (56.2 ± 15.3 vs. 64.0 ± 18.1 minutes; P=0.001) and required less antiemetic drugs during the first four hours after surgery (P=0.03). Pain was well controlled and patients were comfortable per- and post-operatively. Excluding ecchymosis (38.0% LA vs. 21.6% GA; P=0.01), the rate of minor complications did not differ between the two groups: infection, inflammation or edema (14.1 vs. 18.2%; P=0.13), hematoma (1.4 vs. 2.7%; P=0.52) and epistaxis (22.5 vs. 14.2%; P=0.44). Rates of recurrent symptoms and/or re-intervention (11.3 vs. 13.1%; P=0.91) were comparable for LA and GA. This study suggests that external DCR performed under LA and monitored anesthesia care may be advantageous. The length of surgery is reduced, post-operative side effects are diminished, and excluding ecchymosis, the rate of minor complications is not increased. These benefits are desirable in a predominantly elderly population where avoidance of GA risks is at times necessary.

Clinical Outcome of Dacryocystorhinostomy with Septal Deviation

Purpose: Septal deviation has few subjective symptoms. However, a difficulty remains in doing DCR (dacryocystorhinostomy) in these patients. We investigate the clinical course of DCR in patients with a septal deviation. Methods: Acquired nasolacrimal duct-obstructed patients who had undergone DCR with septal deviation from 2003 to 2006 in our hospital were retrospectively analyzed. We measured the septal distance using paranasal computed tomography taken preoperatively and compared the sex and age of patients, the kinds of operations, outcome of surgery, and ocular and nasal complications in our analysis. Results: Twenty-two eyes of 22 patients with a mean age of 55.3 years (range 29～74) were analyzed (4 males, 18 females). Mean septal distance was 4.84 mm (range 2.18～6.99 mm). Nineteen eyes had endonasal DCR, and three had external DCR. Two had DCR combined with septoplasty. Three had septoplasty as a secondary operation, Nasal complication was synechiae in 9 eyes. DCR success was seen in 15 eyes, and DCR failure in 7 eyes. Septal distance was not correlated with DCR success but was correlated with nasal complication (Mann-Whitney test, p=0.003) Conclusions: In the case of DCR with septal deviation, the surgical technique used will need to minimize the mucosal injury and ensure appropriate nasal correction to prevent future complications.

Lacrimal drainage obstruction and dacryocystorhinostomy in children

To determine the outcome of dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) in children. A review of medical records of 104 cases (82 patients) of paediatric DCR who underwent DCR at the Sydney Eye Hospital from 1995 to 2004. The main outcome measures included post-operative symptomatic relief of presenting symptoms, complications, subjective visibility of any scar, and general satisfaction. Statistical methods included chi(2) tests, and Student's t-tests for the comparison of variables among groups. Ninety-four external, 10 endoscopic primary procedures, and five revision procedures were included. Fifty-six of the cases were primary NLDO, and 48 were secondary NLDO. The mean follow-up was 1.44 years. Average age at surgery was 6.6+/-4.2 years (mean+/-SD). Ninety-one eyes needed DCR for the involvement of the lower lacrimal outflow system, and 13 eyes were NLDO associated with congenital punctual/canalicular dysgenesis.Most of the complications of external DCR were related to Jones tube placement. Five cases (4.8%) needed DCR revision. There was a significantly higher incidence of revision surgery in the non-stented group (P<0.01), and the Jones tube group (P<0.001) as compared with the silicone intubation stent group. External DCRs have acceptable long-term clinical and cosmetic results, and low post-operative complication rate. Cases with punctal stenosis or those requiring Jones tube insertion are associated with a higher complication rate. Silicone intubation is associated with a lower need for operative revision.

Outcomes of dacrocystorhinostomy in patients with head and neck tumors

5584 Background: To evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors. Methods: The clinical records of all 31 patients with head and neck tumors who underwent DCR for nasolacrimal duct blockage at M.D. Anderson Cancer Center between 1999 and 2003 were retrospectively reviewed for outcome and complications of DCR. Results: Nasolacrimal duct blockage was diagnosed in 35 eyes of 31 patients. The tumor diagnoses were as follows: squamous cell carcinoma (SCCA), 18 patients (16 had paranasal-sinus SCCA and 2 had skin SCCA); chondrosarcoma, 3; sinonasal carcinoma, 2; adenoid cystic carcinoma, 2; sinonasal papilloma, 2; esthesioneuroblastoma, 1; hemangiopericytoma,1; ameloblastoma,1; and ostoesarcoma,1. Twenty-one patients had a maxillectomy and 7 patients had other sinus surgeries before DCR. Six patients had had silicone intubation at the time of maxillectomy but later developed epiphora and nasolacrimal duct blockage. Ten patients had radiotherapy and 14 had chemotherapy and radiotherapy before DCR. The mean time between completion of radiotherapy and DCR was 24 months (median, 31.5 months), and the mean time between completion of chemotherapy and DCR was 21.5 months (median, 12.5 months). All 31 patients (35 eyes) experienced improvement of epiphora after DCR, but in 4 patients (4 eyes), epiphora recurred during the study period. Probing and irrigation in these 4 patients revealed recurrent nasolacrimal duct blockage. In 1 of these 4 patients, tumor recurrence in the nasal cavity was the cause; he subsequently underwent a total rhinectomy. In another patient, recurrent blockage was due to extrusion of the Pyrex glass tube, which was later replaced. The other 2 patients with recurrent blockage elected not to have additional surgery. None of the patients who had had radiotherapy developed osteoradionecrosis. Two patients had mild wound infections, which resolved after 1 week of systemic antibiotic therapy. Conclusions: DCR alleviates nasolacrimal duct blockage in the majority of patients with head and neck tumors with this side effect. No significant financial relationships to disclose.

Outcomes of dacryocystorhinostomy in patients with head and neck tumors

The purpose of this study was to evaluate the outcomes of dacryocystorhinostomy (DCR) in patients with head and neck tumors. The clinical records of all 31 patients with head and neck tumors who underwent DCR for nasolacrimal duct blockage at The University of Texas M. D. Anderson Cancer Center between 1999 and 2003 were retrospectively reviewed. The tumor diagnoses were squamous cell carcinoma (n = 18), chondrosarcoma (n = 3), sinonasal carcinoma (n = 2), adenoid cystic carcinoma (n = 2), sinonasal papilloma (n = 2), esthesioneuroblastoma (n = 1); hemangiopericytoma (n = 1); ameloblastoma (n = 1), and osteosarcoma (n = 1). Twenty-eight patients had a maxillectomy or other sinus surgeries, 10 had radiotherapy, and 14 had chemotherapy and radiotherapy before DCR. All 31 patients (35 eyes) experienced improvement of epiphora after DCR, but five patients (six eyes) had recurrent nasolacrimal duct blockage develop during the study period. Two patients had mild wound infections; none had osteoradionecrosis. DCR alleviates nasolacrimal duct blockage in most patients with head and neck tumors and is not associated with unusual complications in this setting.

Dacryocystorhinostomy for Dacryocystitis Caused by Methicillin- resistant Staphylococcus aureus: Report of Four Cases

Background: To evaluate the outcome of dacryocystorhinostomy (DCR) for dacryocystitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Cases: Four otherwise healthy patients with dacryocystitis caused by MRSA were studied (3 with chronic dacryocystitis; 1, acute dacryocystitis). Ophthalmic symptoms were epiphora with purulent discharge in 2 cases, with blepharoconjunctivitis in 1 case, and with lacrimal fistula in 1 case. Culture of the purulent discharge from the affected conjunctival sacs revealed MRSA infection. Initial treatment, which was unsuccessful, included intravenously administered common antibiotics, the use of topical antibiotics and povidone-iodine in the conjunctival sac and mupirocin ointment in the nasal cavity. Subsequently, standard DCR was performed with a bicanalicular silicone tube inserted under local anesthesia, accompanied by the administration of common antibiotics. Observation: Cultures from all patients were negative for MRSA as soon as 4 days after DCR. None of the patients had epiphora with pus, and the lacrimal passage became patent postoperatively. Conclusion: Dacryocystitis due to MRSA was resistant to conservative therapy. DCR subsequent to the conservative therapy resulted in almost immediate resolution of the lacrimal fistula and nasolacrimal obstruction, rapid control of dacryocystitis, and a decrease in the period of MRSA infection in the conjunctiva and the nasal cavity.