Traditionally, acute dacrocystitis has been treated conservatively with antibiotics, analgesia and warm compresses, with surgery reserved for later when the infection has subsided. This meta-analysis looks at early vs. late endonasal dacrocystorhinostomy (DCR) in the treatment of acute dacrocystitis, looking at six papers which compared the two approaches. The primary outcome measure was of successful surgery, defined as the presence of a patent ostium and resolution of infection and epiphora. The results are quite striking, showing a significantly quicker resolution of pain and medial canthus swelling in the early DCR group compared to the delayed group. There were four cases of laceration of the inferior punctum and three in the acute intervention group, and three cases of medial canthus fistula formation in the delayed group, but no such complications in the early DCR group. A further study described recurrent attacks of dacrocystitis in the delayed group, and one patient developed cicatricial punctal ectropion due to extensive scarring at the surgical site. There were no such complications in the acute group and also no descriptions of increased rate of haemorrhage or spread of infections by operating early in the acute phase. Whilst this study looks at a limited number of patients and results should be interpreted with caution, I think it provides good evidence that one could consider operating early with an endonasal DCR in patients presenting with acute dacrocystitis.
Early DCR may be better than delayed in acute dacrocystitis?
Early Endonasal Dacrocystorhinostomy for Acute Dacrocystitis: A systematic review and meta-analysis.
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