A Silastic Sheet found during Endoscopic Transnasal Dacryocystorhinostomy for Acute Dacryocystitis

Abstract

PurposeTo report the case of a silastic sheet that was found during an endoscopic transnasal dacryocystorhinostomy for treatment of acute dacryocystitis with necrosis of the lacrimal sac.MethodsA thirty-two year old male presented with painful swelling on the nasal side of his left lower lid two weeks prior to visiting this clinic. Fourteen years ago, the patient was involved in a traffic accident and underwent surgery to reconstruct the ethmoidal sinus. Lacrimal sac massage showed a regurgitation of a purulent discharge from the left lower punctum. Therefore, the patient was diagnosed with acute dacryocystitis and an endoscopic transnasal dacryocystostomy was performed the next day.ResultsThe surgical finding showed severe necrosis around the lacrimal sac and a 20 × 15-mm sized silastic sheet was found crumpled within the purulent discharge. The sheet was removed, the lacrimal sac was irrigated with an antibiotic solution, and a silicone tube was intubated into the lacrimal pathway. After surgery, the painful swelling on the nasal side of left lower lid resolved gradually, and there were no symptomatic complications three months later.ConclusionsWe report the first case where a silastic sheet applied during a facial reconstruction had migrated adjacent to the lacrimal sac resulting in severe inflammation.

Recurrent Dacryocystitis and Lacrimocutaneous Fistula Caused by a Retained Griffiths’ Collar Button Stent

“…9 Moreover, there are several widely accepted methods to greatly decrease the risk of the contracture of the fistula, including use of intraoperative mitomycin C, 12 creation of a large osteotomy, [13][14][15][16] and extensive suturing of the nasal mucosal flaps, [13][14][15] all of which may make the Griffiths' stent unnecessary. [1][2][3][4][5][6] The present patient had persistent epiphora and recurrent dacryocystitis, which had been attributed to recurrent stenosis of the nasolacrimal ostium. 9,11 Patients with lacrimal foreign bodies usually present with partial or intermittent lacrimal sac obstruction and recurrent dacryocystitis.…”

“…9 Foreign bodies in the lacrimal system are uncommon and frequently undiagnosed. [1][2][3][4][5][6] Here, we describe a case of recurrent dacryocystitis resulting in the spontaneous extrusion of a forgotten Griffiths' collar button stent through the lacrimocutaneous fistula 7 years after an endonasal DCR. 6 Complications of foreign bodies include granuloma development and extrusion.…”

“…[1][2][3][4][5][6] Dacryocystorhinostomy (DCR) creates a new drainage pathway to bypass and relieve nasolacrimal duct obstruction. [1][2][3][4][5][6] Dacryocystorhinostomy (DCR) creates a new drainage pathway to bypass and relieve nasolacrimal duct obstruction.…”

Long‐term outcomes of powered endoscopic dacryocystorhinostomy in acute dacryocystitis

“…Acute dacryocystitis is defined as “a medical urgency which is clinically characterized by rapid onset of pain, erythema and swelling, classically below the medial canthal tendon with or without pre‐existing epiphora mainly resulting from the acute infection of the lacrimal sac and perisac tissues.” If left untreated or inadequately managed, it can lead to complications such as orbital cellulitis, orbital abscess, superior ophthalmic vein thrombosis, and meningitis . One of the major limiting factors in performing an external dacryocystorhinostomy (DCR) in acute dacryocystitis is the degree of inflammation, which makes the surgical procedure difficult and may subsequently impact the outcomes . In contrast, the role of endoscopic DCR during the acute phase of dacryocystitis is increasingly being recognized as a safe alternative that decreases morbidity and hastens recovery .…”

“…[3][4][5] One of the major limiting factors in performing an external dacryocystorhinostomy (DCR) in acute dacryocystitis is the degree of inflammation, which makes the surgical procedure difficult and may subsequently impact the outcomes. [6][7][8][9][10][11][12][13][14] In contrast, the role of endoscopic DCR during the acute phase of dacryocystitis is increasingly being recognized as a safe alternative that decreases morbidity and hastens recovery. 1,[6][7][8][9][10][11][12][13][14] With the establishment of endoscopic DCR as an equally effective modality for the treatment of persistent and complex congenital nasolacrimal duct obstruction (CNLDO), recurrent pediatric acute dacryocystitis is also being recognized as one of the indications for surgery during the acute phase.…”