Dacryocystectomy with Lacrimal Silicone Intubation in Challenging Patients Affected by Recurrent Dacryocystitis and Epiphora: Expanding Minimally Invasive Approach Indications

Abstract

Objective: In this study, we evaluated the feasibility and safety of dacryocystectomy associated with lacrimal intubation, for the treatment of recurrent dacryocystitis and epiphora secondary to lacrimal obstruction with compromised lacrimal sac, was evaluated. Subjects and Methods: 32 patients underwent dacryocystectomy with Crawford tubes canalicular insertion, performed by a single surgeon. Post-operative visits were scheduled at 1st and 10th day, 1, 3, and 6 months. At each follow-up visit, the prevalence of epiphora and dacryocystitis was evaluated and compared with baseline data. Also, we evaluated the prevalence of local and systemic post-operative adverse events during the follow-up period. Results: 11 patients (34.38%) reported persistent epiphora, which lasted for 30 days after surgery. Among them, 9 subjects (28.13%) complained occasional epiphora even at the six months follow-up. In the event of dacryocystitis or subacute phlogosis before surgery, patients reported a definitive symptom resolution. Other reported adverse events were epithelial corneal erosion due to Crawford tube protrusion (4 cases, 12.5%), a Crawford tube extrusion case (3.13%), 3 cases of surgical wound dehiscence (9.36%), and a case of mild local bleeding persisting for 15 days Conclusion: A significative epiphora reduction was observed after surgery with an acceptable safety profile, expanding dacryocystectomy indications. This procedure provides a satisfactory resolution of recurrent dacryocystitis. However, this approach should be performed only in well-selected cases: elderly/frail patients with altered lacrimal sacs, epiphora associated with recurrent infections, and failure after dacryocystectomy.