Uma Maheswari, M (2015) A clinical study on role of endonasal dacryocystorhinostomy in the treatment of acute dacryocystitis and its outcome. Masters thesis, Madras Medical College, Chennai.
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Abstract
AIM OF THE STUDY: To determine the role of the endonasal Dacryocystorhinostomy in the treatment of acute dacryocystitis and to assess the success rate of the procedure. MATERIALS AND METHODS: A prospective study was carried out on 30 patients at Orbit and Oculoplasty clinic, RIO-GOH, Chennai during the period of from October 2013 to August 2014. SELECTION CRITERIA: 30 patients who presented with acute dacryocystitis were included in this study. Out of 30 patients 26 were female patients and 4 were male patients. They were in the age group of 20-58 years and there was no history of major systemic illness like diabetes or hypertension among them. All the patients underwent primary endonasal DCR. Inclusion Criteria: All the cases of acute Dacryocystitis with abscess with established nasolacrimal duct obstruction were included in the study. Exclusion Criteria: 1. Cases with canalicular and punctal obstruction. 2. Cases with ectropion or entropion. 3. Cases with noticeable lower lid laxity. 4. Cases of congenital malformations of lacrimal apparatus and craniofacial anomalies. 5. Cases of tumours of the lacrimal apparatus and nasal cavity. 6. Cases with lacrimal fistulae and chronic dacryocystitis. 7. All recurrent cases due to failed external dacryocystorhinostomy. 8. Cases with deviated nasal septum on the same side. DISCUSSION AND RESULTS: Acute dacryocystitis is more common on the right side Acute dacryocystitis is more common among females. This is because of the narrow lumen in the bony canal which leads to partial or complete closure of the NLD. Acute dacryocystitis is more common in 5th decade. Acute dacryocystitis presents with complaints of pain, watering, discharge, swelling in the lacrimal sac region and occasionally with pre septal cellulitis and lacrimal abscess. ROPLAS test and lacrimal syringing are contra indicated in the acute phase of the disease. The diagnosis is made exclusively on clinical signs and symptoms. The conventional treatment for a case of acute dacryocystitis includes warm compresses, use of systemic antibiotic therapy, percutaneous route of drainage of the abscess and plan for external DCR after complete resolution of infection. This however may result in formation of cutaneous fistula formation, risk of incidence of recurrent infection before external DCR, prolong the illness and intake of antibiotic therapy. The procedure of external DCR is contraindicated in acute dacryocystitis. Because it spreads the infection via the tissue planes, exacerbates inflammation and causes septicemia. An endonasal approach reduces these complications since the lacrimal sac abscess is approached via the noninfected and less inflamed tissue areas. Endonasal drainage of the abscess causes rapid resolution of symptoms and signs. If the acute dacryocystitis is left unattended it may lead to the formation of lacrimal abscess which may burst open and leads to the formation of lacrimal fistula. These complications can be avoided by timely intervention by endonasal DCR. Endonasal DCR is associated with less intra operative and early postoperative complications like injury to neighbouring structures. CONCLUSION: Endonasal dacryocystorhinostomy is proved to be the treatment of choice in cases of acute dacryocystitis, compared to previous conventional external DCR. Endonasal DCR is a real boon in this world of upcoming cosmetic surgeries. As capsule endoscopies in gastroenterology and micro incision phacoemulsification in cataract surgery, endonasal DCR is now dominating the field of lacrimal surgery. It gives less pain, edema, bleeding, fistula formation. Being aesthetically more acceptable it causes no scar, no adhesions. It lessens the hospital stay, and provides an additional economic benefits for the patient by avoiding readmission for external DCR and prevents fistula formation. The overall success rate of this procedure in this study is 90%.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | endonasal dacryocystorhinostomy ; treatment ; acute dacryocystitis ; clinical study. |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Devi S |
| Date Deposited: | 06 Oct 2018 16:10 |
| Last Modified: | 06 Oct 2018 16:10 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9693 |
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