The Endoscopic Endonasal Dacryocystorhinostomy (eDCR) in the Immunocompromised Patient

Area of Science:

• Ophthalmology
• Immunology
• Otolaryngology

Background:

• Common Variable Immunodeficiency (CVID) can present with complex sinonasal and orbital manifestations.
• Chronic dacryocystitis and lacrimal sac empyema pose significant management challenges, especially in immunocompromised patients.
• Limited literature exists on managing dacryocystitis in patients with CVID, necessitating careful diagnostic and therapeutic evaluation.

Purpose of the Study:

• To present a clinical case of a patient with CVID and recurrent dacryocystitis.
• To describe the diagnostic and therapeutic approach for complex lacrimal sac pathology in an immunocompromised patient.
• To discuss the rationale behind the chosen surgical technique and management strategy.

Main Methods:

• Endoscopic endonasal dacryocystorhinostomy using "cold" instruments.
• Radiological evaluation for accurate diagnosis.
• Management balancing post-surgical follow-up with pandemic-related infectious risks.
• Consideration of oral and topical therapies to prevent infectious complications.

Main Results:

• Successful endoscopic endonasal dacryocystorhinostomy with no immediate post-surgical complications.
• Patient management adapted to minimize infectious risk during a pandemic.
• Discussion of surgical technique, avoidance of prostheses, and therapeutic strategies.

Conclusions:

• Endoscopic endonasal dacryocystorhinostomy with "cold" instruments is a viable option for CVID patients with complex dacryocystitis.
• Careful pre-operative evaluation and tailored post-operative management are crucial.
• Balancing necessary medical care with infectious risk mitigation is essential in immunocompromised patients, particularly during public health crises.