How is hemorrhage managed during surgery for dacryocystitis?

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

Dacryocystorhinostomy, when properly performed, is a very safe and effective procedure. However, as with all surgical procedures, severe complications can occur.

Hemorrhage is the most notable complication and has been reported to occur in approximately 3% of patients. Considerations are as follows:

  • Bleeding is encountered commonly from the angular vessels, the nasal mucosa, and, occasionally, the anterior ethmoidal artery.

  • Most cases of hemorrhage can be controlled with judicious use of cautery and cottonoids soaked in thrombin. Rarely, the nose must be packed.

  • Any surgeon performing a dacryocystorhinostomy should be adept at placing an anterior nasal pack.

  • A posterior nasal pack usually is not required. It has been noticed that insertion of an absorbable homeostatic agent, such as Instat or Gelfoam, soaked in thrombin is effective in decreasing the incidence of hemorrhage.


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