The Clinical Manifestations and Treatment Results of Congenital Lacrimal Fistula

PURPOSE: To evaluate the clinical manifestations and the results of treatment in congenital lacrimal fistula. METHODS: We retrospectively evaluated the symptoms, associated anomalies, and results of treatment in patients with congenital lacrimal fistula. RESULTS: The mean age of the 22 total patients was 22.5+/-24.6 years (4 months~77 years). Associated anomalies were shown in two patients - one with hearing loss and upper punctal atresia, and the other with imperforate anus and undescended testes. Symptoms were tearing in 18 eyes and subcutaneous nodule in 3 eyes. Most of the external ostium of the fistula were located at the skin inferomedial (16 eyes) or medial (5 eyes) to the medial canthus, but one case had external ostium at the medial palpebral conjunctiva. Symptom improved in all patients after fistulectomy with bicanalicular intubation in 12 eyes, fistulectomy in 1 eye, bicanalicular intubation in 1 eye, and dacryocystorhinostomy combined fistulectomy with bicanalicular intubation in 2 eyes. However, the fistula recurred in 3 cases (19%). CONCLUSIONS: Lacrimal fistula is a congenital anomaly which can cause tearing or subcutaneous nodule. Treatment appropriate to the patient is required to get favorable result.

The Clinical Effect of Endonasal Dacryocystorhinostomy in the Treatment of Acute Dacryocystitis

PURPOSE: To evaluate the clinical effect of endonasal dacryocystorhinostomy as a primary treatment of acute dacryocystitis with lacrimal sac abscess formation. METHODS: The study comprised 14 patients with acute dacryocystitis and lacrimal sac abscess formation who underwent endonasal dacryocystorhinostomy as a primary treatment. Postoperative evaluations included symptoms of acute dacryocystitis, physical examination, and lacrimal irrigation. Success was defined as the absence of epiphora and good lacrimal irrigation at the last follow-up. RESULTS Of the patients, two were male and twelve were female. The mean age was 54.7 years and mean follow-up period was 8.3 months. Resolution of symptoms and signs of acute dacryocystitis occurred in all patients. In one patient, recurrence of acute dacryocystitis occurred 6 months after surgery. At last follow-up, epiphora and failure of lacrimal irrigation had developed in two patients. CONCLUSIONS: Endonasal dacryocystorhinostomy is considered a safe and effective primary treatment of acute dacryocystitis with lacrimal sac abscess formation.