Nasolacrimal duct screening to minimize post-cataract surgery endophthalmitis

To examine unrecognized nasolacrimal duct obstruction as a risk factor for developing endophthalmitis post-cataract surgery in order to assess the value of preoperative lacrimal system screening.

Prospective case-control study.

A random sample of patients undergoing phacoemulsification cataract surgery (control group) and a consecutive series of patients admitted to our hospital with post-cataract surgery endophthalmitis.

We compared the rate of nasolacrimal duct obstruction in the control group versus the endophthalmitis series. Both groups underwent nasolacrimal duct syringing with normal saline on the ipsilateral side to the surgery. A standard macro-dacryocystogram was performed to confirm for obstruction detected on syringing.

Nasolacrimal duct obstruction rate.

Forty-four eyes from 39 patients were included in this study: 34 eyes from 29 patients formed the control group and 10 eyes from 10 patients formed the endophthalmitis group. A higher rate of nasolacrimal duct obstruction was found among patients who developed endophthalmitis post-cataract in comparison with the control group, on both nasolacrimal duct syringing (50.0% vs. 11.8%; P = 0.018) and macro-dacryocystogram (20.0% vs. 2.9%, P = 0.125). Two out of the three patients with radiologically confirmed nasolacrimal duct obstruction reported a long history of epiphora.

The higher rates of obstruction on nasolacrimal duct syringing and macro-dacryocystogram among patients who developed endophthalmitis suggest that nasolacrimal duct obstruction is a significant risk factor for postoperative endophthalmitis. We recommend routine screening for symptoms and examination of the lacrimal system prior to cataract surgery.