• Oculoplastics/Orbit

    Review of: Shifting to very early endoscopic DCR in acute suppurative dacryocystitis

    Pakdel F, Soleimani M, Kasaei A, et al. Eye, September 2020

    Researchers detail the outcomes of very early endoscopic dacryocystorhinostomy (DCR) in patients with acute dacryocystitis and abscess formation.

    Study design

    In this prospective, nonrandomized comparative study, 41 eyes of 41 patients with acute dacryocystitis with abscess formation were assigned to 1 of 2 treatment groups: group 1 underwent standard late external transcutaneous DCR and group 2 underwent early endoscopic DCR that took place within 3 days of the first visit. All patients received systemic antibiotics.

    Outcomes

    At the mean follow-up of 14 months, anatomic, functional and overall success were not statistically different between groups. However, mean duration of the cellulitis was 8 days in the very early DCR group and 16 days in the standard DCR group (P=0.027).

    Limitations

    Although prospective, the study was not randomized; it would be good to know why randomization was not performed and what prompted the authors to place patients in one group or the other (i.e., was there any bias). There was an age difference between the 2 groups, which was statistically significant. It is unclear if this difference affected the results of the study. In addition, it was unclear if any of the patients had secondary/systemic causes of their nasolacrimal duct obstruction, or whether this was purely primary acquired nasolacrimal duct obstruction. It would have been ideal to have a late endoscopic DCR group as a closer comparison.

    Clinical significance

    Traditional teaching in the treatment of acute dacryocystitis is to “cool down” the infection followed by a DCR. This study demonstrates that early intervention with an endoscopic DCR has a similar success rate to a late DCR and has the advantage of decreasing the duration of cellulitis.