An update on endoscopic mechanical and powered dacryocystorhinostomy in acute dacryocystitis and lacrimal abscess

To provide a brief review of the literature on the utility and outcomes of endoscopic dacryocystorhinostomy (DCR) in patients with acute dacryocystitis (ADC) and lacrimal abscess.

The authors performed a PubMed search of all articles published in English on endoscopic powered or mechanical DCR performed during the stage of acute dacryocystitis. Data captured include demographics, clinical presentations, time interval to surgery, intraoperative challenges, post-operative course, complications and outcomes. Specific emphasis was laid on addressing the intra-operative challenges and post-operative outcomes.

Increased intra-operative bleeding is a common finding. The use of mitomycin C and silicone intubation are not uncommon and are not reported to have negative influence on the outcomes of surgery. The general consensus is to initiate antibiotics immediately or a day before surgery and continue them in the post-operative period. Symptomatic pain relief was achieved very early (immediate to <3 days) and complete resolution was usually achieved in a week's time. The overall anatomical success rates varied from 81.8 to 96.2% and functional success from 72.7 to 96.2%. Cicatricial closure of the ostium was a common cause of failure.

Primary endoscopic DCR appears to be an effective modality in the management of ADC and lacrimal abscess, and results in a rapid resolution of inflammation while achieving comparable surgical success with a traditional approach of conservative management with or without drainage and 2nd stage external DCR.