Efficacy of external dacryocystorhinostomy in post-acute dacryocystitis: A comprehensive 10-year study

Objectives: The purpose of the study is to analyze demographics, clinical presentation, management, and outcomes in post-acute dacryocystitis patients who underwent external dacryocystorhinostomy (DCR). Material and Methods: This is a retrospective study in institutional setting. Electronic medical records of 107 eyes of 104 patients who underwent external DCR post-acute dacryocystitis by a single surgeon over a decade (October 2013–December 2023) were analyzed. Data include demographics, clinical examination, acute symptoms and epiphora duration, medical and surgical interventions, outcomes, and complications. Patients without a history of acute symptoms, canalicular block, or facial trauma were excluded from the study. Intervention: Initial management included broad-spectrum oral (amoxicillin and potassium clavulanate 625 mg or ciprofloxacin 500 mg) and topical antibiotics. External DCR was a definitive surgical technique, with or without intubation. Main outcome measures include anatomical and functional success assessed by patency on syringing and absence of epiphora post-surgery. Results: The mean age was 53.66 years (range: 20–78 years). There was a female predominance without laterality preference. Acute swelling in the lacrimal sac area (53.2%) was the most common presentation. Acute symptom duration ranged from 1 to 30 days. Eleven patients presented with encysted mucocele with acute symptoms, three had spontaneously burst lacrimal abscess, and two had fistula. Two required incision and drainage. Most had only one acute episode. The mean interval between initial presentation and surgery was 2.7 weeks (median: Two weeks, range: One week–six weeks). Canalicular intubation was performed in 68 eyes (63.55%). Patients were reviewed on post-operative day 1, week 2, and month 3. Anatomical success of DCR was 96.26%, and functional success was 94.39%. Stent prolapse was the most common complication. Early post-operative nasal bleeding occurred in three patients. Conclusion: External DCR with silicone intubation can be a good option in post-acute dacryocystitis patients, with a 96.26% anatomical success rate. Adequate inflammation control, meticulous surgical steps, and appropriate use of adjuncts like silicone tube intubation are essential.