Comparison success of Early Endonasal Endoscopic versus delayed External Dacryocystorhinostomy with in Acute Suppurative Dacryocystitis

Purpose: Conventional treatment for acute dacryocystitis with abscess formation consists of systemic antibiotics, percutaneous abscess drainage and late DCR. However, early endoscopic approach to the inflamed lacrimal sac may be used as an alternative to delayed external dacrocystorhinostomy (Ex-DCR) preventing exacerbation and spread of infection, increased surgical morbidity, and unpredictable scarring. Furthermore, it may provide both drainage of lacrimal sac abscess and establish lacrimal drainage patency in one session. In this study we aimed to investigate efficacy and safety of early endonasal endoscopic dacrocystorhinostomy (En-DCR) in acute suppurative dacryocystitis (ASD).Methods: Consecutive patients referred with ASD and lacrimal abscess underwent ether in Group 1: En-DCR, within five days after starting systemic antibiotic or in Group 2 : Ex-DCR after systemic antibiotics and resolution of cellulitis., from June 2013 to September 2014. Resolution of clinical findings of cellulitis, resolution of epiphora and discharge, patency of lacrimal drainage assessed by subjective modified Munk scale (subjective success) and objective irrigation test (anatomical success).Results: : Twenty-two patients with ASD that underwent En-DCR and 19 ptients that underwent Ex-DCR were included. There was no significant difference in demographic data. Mean follow-up time was 14.73 (SD=±3.01) months in group 1 and 13.3 (SD=± 1.2) in group 2. Postoperative Overall success rate was 86.4 (86.4% in group 1 and 89.5% in group 2 (p=0.7). No remarkable complications was observed in either groups.Conclusion: Early En-DCR in acute suppurative dacryocystitis could both hasten resolution of abscess and cellulitis and nasolacrimal duct obstruction with a low morbidity and regarded as an alternative management option in patients with ASD.