Our experience in contemporary treatment of lacrimal drainage system

Abstract

Introduction: The diagnosis and treatment of lacrimal drainage system is an important compartment in ophthalmology. Currently, in the literature is presented numerous methods and techniques for restoring lacrimo-nasal drainage both drug-conservative as well as surgical, each presenting advantages and disadvantages. Diagnosis and treatment of disorders of the lacrimal pathways although successful, but at the same times a complicated problem and not solved until fine. The data presented in the literature and our daily activity dictates the need of a deeper examination of patients with tearing, early diagnosis of catarrhal and purulent dacryocystitisas manifested by a cosmetic and functional discomfort in patients lives. The aim: to study etiopathogenesis and effectiveness of conservative and surgical treatment of lacrimal drainage system pathology and analyzing the results.

Methods: It was a retrospective study of 244 patients from the Ophthalmology Department of the Municipal Hospital “Sfanta Treime” during the years 2009-2014

Results: The most common diseases remain: punctal stenosis (n=91), chronic dacryocystitis (n=76), dacryoadenitis (n=18), phlegmon of the lacrimal sac (n=59). 116 patients were examined preventive in polyclinic. They represented: punctal stenosis- 62.93%; chronic dacryocystitis- 33.62%; dacryoadenitis- 1.72%; phlegmon of the lacrimal sac-1.72% cases. In emergency department were examined 111 patients with phlegmon of the lacrimal sac, of which 102 cases have required hospital treatment (91.89%), remaining patients (8.11%) received outpatient treatment. All patients received conservative treatment and/or surgery. Thus, patients treated conservatively were punctal stenosis (37.29%), chronic dacryocystitis (31.14%); dacryoadenitis 97.37%), lacrimal sac phlegmon (24.18%). 205 patients (84.01%) of 244 hospitalized whith pathology of lacrimal drainage system required surgical intervention. Thus, punctal stenosis were 86 interventions (35.24%), chronic dacryocystitis- 60 interventions (24.59%), phlegmon of the lacrimal sac - 59 interventions (24.18%).

Conclusions: Most of hospitalized patients with the lacrimal tract pathology received surgery treatment. The most frequent intervention was dacryocystorhinostomia (DCR) which represent the standard method in surgery of the lacrimal drainage system pathology. Endonasal dacryocystorhinostomia would be a perfect method of substitution of classic dacryocystorhinostomia because it include the lack of a skin incision, shorter operating time, minimal blood loss and less risk of cerebrospinal fluid leakage. However, the success rate of 75% in endonasal DCR compared with a success rate of 90 % set in DCR classic favors resolving cases through conventional surgery.