The Endoscopic Endonasal Dacryocystorhinostomy (eDCR) in the Immunocompromised Patient

Abstract

We present the clinical case of a 51-year-old male patient, affected by common variable immunodeficiency (CVID). In his history recurrent orbital cellulitis, exacerbation of chronic right dacryocystitis, lacrimal sac empyema with periodic episodes of dacryocutaneous fistolization. The coexistence of these particular immunological defects and the lack of literature about similar cases required an accurate evaluation of each step of the diagnostic and therapeutic approach. We performed an endoscopic endonasal dacryocystorhinostomy with “cold” instruments. No surgical complications were observed in the immediate postsurgical period. We balanced the necessity of a follow-up based on frequent office evaluation and the current pandemic emergency, in order to not expose the patient to an additional infectious risk. The discussion will focus on several aspects: the adequacy of radiological, the “cold” surgical technique, the choice of avoiding endocanalicular prostheses. We will discuss also about the use of oral and topical therapy, avoiding probable post-surgical infectious complications.

The efficacy of endoscopic dacryocystorhinostomy in the treatment of dacryocystitis: A systematic review and meta-analysis

“…[23] Surgical success rate was associated with the cause and degree of nasolacrimal duct obstruction, surgical technique and experience, the quality and functionality of surgical equipment and instruments, preoperative preparation, and postoperative care. [24] EDCR is a well-established surgical technique for the treatment of dacryocystitis. This procedure has the advantages of short surgical time, less trauma, less bleeding, quicker recovery, no scarring, no impact on facial aesthetics, simultaneous management of comorbid intranasal lesions, and repeatability.…”

“…[ 23 ] Surgical success rate was associated with the cause and degree of nasolacrimal duct obstruction, surgical technique and experience, the quality and functionality of surgical equipment and instruments, preoperative preparation, and postoperative care. [ 24 ]…”