Lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy

Purpose: To evaluate the success of lacrimal sac empyema incision and drainage followed by early external dacryocystorhinostomy. Methods: Interventional consecutive case series conducted in Farabi Eye Hospital between August 2007 and November 2010. Patients with acute dacyocystitis and lacrimal sac empyema underwent incision and drainage, followed by early (less than 4 weeks) external DCR. Data collection included patient demographics, past medical history, procedure technique, culture results, and formation of a persistent cutaneous fistula. Results: A total of 32 patients were included: 87.5% had a positive history of chronic epiphora before dacryocystitis. Of these 32 cases, 55.6% had positive culture. Staphylococcus aureus was the most common organism with 8 isolates (38%). The average number of days between empyema drainage and DCR was 11.44 days. All patients had complete resolution of dacryocystitis, with no recurrence during the follow-up period. Neither of 32 patients treated with early DCR after primary empyema drainage, developed a persistent lacrimal-cutaneous fistula. Conclusions: Incision and drainage of the lacrimal sac empyema followed by early external dacryocystorhinostomy can be an appropriate treatment strategy for acute dacryocystitis.