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.
Read full abstract