What is the role of surgery in the treatment of dacryocystitis?

Updated: Oct 08, 2019
  • Author: Grant D Gilliland, MD; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

Chronic dacryocystitis almost always dictates surgery for correction of symptomatology. If caused by allergic rhinitis or mild mucosal inflammation of the nasolacrimal duct mucosa, chronic dacryocystitis may improve with topical steroid drops. Occasionally, infracting of the inferior turbinate bone, submucous resection of the turbinate, and/or lacrimal outflow probing may be successful treatment of dacryocystitis.

In general, dacryocystitis is a surgical disease. Surgical success rates in the treatment of dacryocystitis are approximately 95%.

Acute cases are best treated surgically after the infection has subsided with adequate antibiotic therapy. [13] For acute dacryocystitis, some clinicians perform external dacryocystorhinostomy several days after initiating systemic antibiotics. Rarely, dacryocystorhinostomy must be performed during the acute phase of the infection to facilitate clearing of the infection.

Some surgeons use an endonasal approach to dacryocystorhinostomy surgery with or without a laser. [14] This may be appropriate in patients with chronic dacryocystitis. Lacrimal sac fistulization into the nose (dacryocystorhinostomy) has been performed successfully via a transcanalicular approach using a CO2 or KTP laser.

Balloon dacryoplasty has been popularized in the last several years. It appears to have a lower long-term success rate than the previous treatment modalities. It should be used in patients with circumscribed focal stenoses or occlusions of the nasolacrimal duct and is contraindicated in acute dacryocystitis, dacryocystolithiasis, and posttraumatic obstruction of the nasolacrimal duct. In one study, the long-term success rate of balloon dacryoplasty was 40.8% for complete obstructions and 68% for partial obstructions. [15]


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