The long-term results of dacryocystoplasty, followed if necessary by repeat dacryocystoplasty, are good. Dacryocystoplasty is a safe and simple procedure and could become the treatment of choice for epiphora due to obstruction of the nasolacrimal ducts. Dacryocystorhinostomy is indicated when dacryocystoplasty or repeat dacryocystoplasty fails or when dacryocystoplasty is contraindicated (e.g., in anatomic malformations in the lacrimal duct or bony canal).
Stents were placed temporarily in 10 obstructed lacrimal systems in patients with a chronic or subacute lacrimal abscess that did not respond to conventional antibiotic therapy. In all 10 cases, the abscess was treated successfully. Long-term patency of the lacrimal system was restored in five cases. Temporary stent placement appears to be a promising method to treat a chronic or subacute lacrimal abscess.
To evaluate the efficacy of internal drainage of a lacrimal abscess, we treated 10 patients with pyocele of the lacrimal sac, who did not want to undergo operative intervention. A temporary nasolacrimal stent was placed in the nasolacrimal duct, and the pussy material was collected for microbiological examination to adjust the preliminary antibiotic treatment which was given systemically and locally. The stents were removed after the infection had subsided clinically. Three years later, there was a recurrence of the infection in only 1 patient. This internal drainage of the lacrimal sac, combined with systemic and local antibiotics, was successful in 90% of the patients.
A 23-year-old male had suffered from epiphora in the left eye since childhood. There was no history of infection or trauma. A supernumerary punctum was seen in the left lacrimal caruncle on examination. Subsequent dacryocystography and computer tomography showed a blind-ended sac that was connected to the supernumerary punctum, but not to the normally developed nasolacrimal system. When distended with secretion, this blind-ended lacrimal sac caused compression and obstruction of the normal lacrimal drainage pathway, which led to epiphora. The epiphora disappeared after surgical removal of the supernumerary system.
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