Shifting to very early endoscopic DCR in acute suppurative dacryocystitis



We aimed to show the outcome of very early endoscopic dacryocystorhinostomy (VE-EDCR) in a routine pool of patients with acute dacryocystitis (AD) and abscess formation compared with the standard late external dacryocystorhinostomy L-ExDCR.


This was a prospective nonrandomized comparative study conducted from June 2013 to March 2016. Patients with AD and abscess formation were referred to our oculo-facial clinic in a university-based hospital. All patients received systemic antibiotics and were assigned to either of treatment groups. Patients in group 1 underwent late external transcutaneous DCR (L-ExDCR) and group 2 underwent EDCR within 3 days after first visit, named VE-EDCR. Primary outcome measure was success of surgery.


Forty-one eyes of 41 patients with acute suppurative AD, were included from June 2013 to March 2016. Twenty-two patients underwent VE-EDCR and 19 underwent L-ExDCR. Mean age of patients was 43.41 (SD = 19.84, range 14–98) years. Mean follow-up was 14 (SD = 2.4) months. Anatomic, functional, and overall success in L-ExDCR and VE-EDCR groups were (89.5 and 86.4%, p = 0.99) (89.5% and 86.4%, p = 0.99) (89.5% and 81.8%, p = 0.66) respectively. Mean duration of cellulitis in VE-EDCR and L-ExDCR were 8.00 (SD = 4.63) and 16.11 (SD = 11.58) days, respectively (p = 0.027). No remarkable adverse event was found.


Success of very early endonasal endoscopic DCR is comparable with the traditional late external DCR. Duration of cellulitis is shorter in VE-EDCR. This therapeutic approach can be considered in patients with acute suppurative dacryocystitis.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Roithmann R, Burman T, Wormald PJ. Endoscopic dacryocystorhinostomy. Braz J Otorhinolaryngol. 2012;78:113–21.

    Article  Google Scholar 

  2. 2.

    Massaro BM, Gonnering RS, Harris GJ. Endonasal laser dacryocystorhinostomy. A new approach to nasolacrimal duct obstruction. Arch Ophthalmol 1990;108:1172–6.

    CAS  Article  Google Scholar 

  3. 3.

    McDonogh M, Meiring JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol. 1989;103:585–7.

    CAS  Article  Google Scholar 

  4. 4.

    Wormald PJ, Kew J, Van Hasselt A. Intranasal anatomy of the nasolacrimal sac in endoscopic dacryocystorhinostomy. Otolaryngol Head Neck Surg. 2000;123:307–10.

    CAS  Article  Google Scholar 

  5. 5.

    Tsirbas A, Wormald PJ. Mechanical endonasal dacryocystorhinostomy with mucosal flaps. Otolaryngol Clin North Am. 2006;39:1019–36.

    Article  Google Scholar 

  6. 6.

    Lee TS, Woog JJ. Endonasal dacryocystorhinostomy in the primary treatment of acute dacryocystitis with abscess formation. Ophthalmic Plast Reconstr Surg. 2001;17:180–3.

    CAS  Article  Google Scholar 

  7. 7.

    Madge SN, Chan W, Malhotra R, et al. Endoscopic dacryocystorhinostomy in acute dacryocystitis: a multicenter case series. Orbit 2011;30:1–6.

    Article  Google Scholar 

  8. 8.

    Bell BG, Schellevis F, Stobberingh E, et al. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014;9:13.

    Article  Google Scholar 

  9. 9.

    Davey P, Marwick CA, Scott CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2:CD003543.

    PubMed  Google Scholar 

  10. 10.

    Wu W, Yan W, MacCallum JK, et al. Primary treatment of acute dacryocystitis by endoscopic dacryocystorhinostomy with silicone intubation guided by a soft probe. Ophthalmology. 2009;116:116–22.

    Article  Google Scholar 

  11. 11.

    Li EY, Wong ES, Wong AC, et al. Primary vs secondary endoscopic dacryocystorhinostomy for acute dacryocystitis with lacrimal sac abscess formation: a randomized clinical trial,". JAMA Ophthalmol. 2017;135:1361–6.

    Article  Google Scholar 

  12. 12.

    Saha R, Sinha A, Phukan JP. Endoscopic versus external approach dacryocystorhinostomy: a comparative analysis. Niger Med J. 2013;54:165–9.

    Article  Google Scholar 

  13. 13.

    Joshi RS, Deshpande AS. Success rate of conventional dacryocystorhinostomy in post-acute dacryocystitis compared to endonasal dacryocystorhinostomy in acute dacryocystitis. J Ophthalmic Vis Res. 2017;12:290–5.

    Article  Google Scholar 

  14. 14.

    Rabina G, Golan S, Neudorfer M, et al. External dacryocystorhinostomy: characteristics and surgical outcomes in patients with and without previous dacryocystitis. J Ophthalmol 2013;2013:287524.

    Article  Google Scholar 

  15. 15.

    Amadi AJ. Endoscopic DCR vs external DCR: What's best in the acute setting? J Ophthalmic Vis Res. 2017;12:251–3.

    Article  Google Scholar 

  16. 16.

    Morgan S, Austin M, Whittet H. The treatment of acute dacryocystitis using laser assisted endonasal dacryocystorhinostomy. Br J Ophthalmol. 2004;88:139–41.

    CAS  Article  Google Scholar 

  17. 17.

    Jain S, Ganguly A, Singh S, et al. Primary nonendoscopic endonasal versus delayed external dacryocystorhinostomy in acute dacryocystitis. Ophthalmic Plast Reconstr Surg. 2017;33:285–8.

    Article  Google Scholar 

  18. 18.

    Naik SM, Appaji MK, Ravishankara S, et al. Acute dacryocystitis with abscess: endonasal dacryocystorhinostomy, the primary treatment of choice. Clin Rhinol. 2012;5:107–13.

    Article  Google Scholar 

  19. 19.

    Duggal P, Mahindroo NK, Chauhan A. Primary endoscopic dacryocystorhinostomy as treatment for acute dacryocystitis with abscess formation. Am J Otolaryngol. 2008;29:177–9.

    Article  Google Scholar 

  20. 20.

    Ali MJ, Joshi SD, Naik MN, et al. Clinical profile and management outcome of acute dacryocystitis: two decades of experience in a tertiary eye care center. Semin Ophthalmol 2015;30:118–23.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Farzad Pakdel.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pakdel, F., Soleimani, M., Kasaei, A. et al. Shifting to very early endoscopic DCR in acute suppurative dacryocystitis. Eye 34, 1648–1653 (2020).

Download citation


Quick links