Effect of revision dacryocystorhinostomy under nasal endoscopy on recrudescent dacryocystitis

Patients with recurrent dacryocystitis are difficult to treat. We aimed to observe the role of dacryocystography in locating the site of obstruction and the effect of revision surgery in these cases of recurrent dacryocystitis.

We prospectively collected patients with recurrent dacryocystitis at West China Hospital of Sichuan University. Dacryocystography was performed before surgery. After revision endoscopy dacryocystorhinostomy (DCR), patients were followed-up regularly. Clinical features were recorded before and after operation, including the visual analog scale (VAS) score. Using the software of SPSS 13.0, VAS scores were compared between preoperation and postoperation by a Student's t test and repeated measure ANOVA.

Twenty patients were collected; eight cases had a history of a one-time occurrence of DCR, and 12 cases had a history of two or more occurrence of DCR. Dacryocystography could show the site with the most lacrimal obstruction. During the operation, we could resect most of the lacrimal sac medial bone wall and expose the sac successfully. Follow-up showed no relapse occurrences and only one case had a slightly tearful eye subjectively but had enough big orificium fistulae and favorable mucosal epithelialization that it was similar to other cases. The VAS scores at follow-up decreased significantly compared with preoperation (P<0.05).

For patients with recurrent dacryocystitis, dacryocystography could clarify the cause and exact site of the obstruction and provide information for further treatment. Through revision endoscope DCR, patients can effectively achieve enough drainage of the lacrimal sac accompanied with a significant improvement in symptoms and no observable complications.