A dacryocystectomy is a surgical procedure used for the destruction or complete removal of the lacrimal sac.
The nasolacrimal drainage system works to channel excess tears from the eye surface to the nasal cavity. It's composed of the puncta lacrimalia, lacrimal canaliculi, lacrimal (tear) sac, and the nasolacrimal (tear) duct. The puncta lacrimalia are tiny holes in the eyelids, which lead to the canalicular tubes. The old tears are pushed through the puncta into the canalicular when the eyes blink. They collect in the tear sac, which serves a reservoir and then flow through the tear duct into the nasal cavity.
Dacryocystectomy may be necessary where the lacrimal sac has malignant tumors. DCT may be required for patients with chronic inflammation or infection of the nasolacrimal sac (dacryocystitis) with severe dry eyes or disorders like systemic lupus erythematosus and Crohn's disease, that predispose nasal scarring.
The surgical technique is also recommended for patients with chronic dacryocystitis who have had multiple dacryocystorhinostomy procedures with unsatisfactory results.
DCT is particularly useful in elderly patients with other ocular conditions such as advanced cataracts, glaucoma, or microbial keratitis. In such cases, the procedure may significantly enhance visual rehabilitation. It's also helpful in elderly patients with cardiac or neurological problems. DCT is preferred to dacryocystorhinostomy for patients above 70 years of age because old age naturally causes nasal mucosa atrophy.
Also Known As
Preparation & Expectation Before Surgery
The patient and the surgeon will discuss the treatment before the procedure. S/he will take the complete patient history and conduct comprehensive eye examination, including:
- Radionuclide dacryoscintigraphy
- Computed tomography (CT) of the sinuses and orbit
- Magnetic resonance imaging (MRI) of the sinuses and orbit
Types, Purpose & Procedure
DCT is one of the procedures to treat chronic dacryocystitis when a dacryocystorhinostomy (DCR) technique is not possible. A DCR procedure creates alternative tear drainage to bypass the blocked system.
A DCT procedure seeks to completely remove the nasolacrimal duct and the tear sac without leaving any lacrimal tissues behind structures. It aims at minimal concomitant damage with structures. The procedure is primarily conducted through an endoscopic approach or an external approach through a skin incision.
Anesthetic and adrenaline solutions are administered into the area surrounding the lacrimal sac. The surgeon makes a precise cut along the crease of skin over the tear sac. S/he completely extracts the tear sac and the nasolacrimal duct and closes the wound with sutures.
Risks, Side Effects & Complications
DCT is a simple and uncomplicated procedure conducted by an experienced oculoplastic surgeon. In rare cases, the patient may experience:
- Infection of the surgical site
- Bleeding due to an accidental cut of the angular vein
- Recurring dacryocystitis in the remnant of the tear sac
- Orbital bleeding, hematomas, and possible loss of sight caused by an accidental damage to the surrounding orbital structures
There will be redness in the area and the patient may experience pain.
Post-operative complications are sporadic and may include:
- Increased tearing
- A visible facial scar
- Breaking of the surgical sutures
After Care, Recovery & Outcome
After the surgery, the patient's nose may be covered with material to minimize the bleeding risk and the breaking of the surgical sutures. The surgeon will prescribe medication to relieve pain and antibiotics, including tablets and ointment, to help prevent infection.
S/he will schedule the follow up visits depending on the objectives of the operation. The stitches will be removed one week after the surgery and medications are discontinued. The redness and pain should resolve within two weeks.
The surgeon will give instructions about how to care for the wound during the recovery period. It may include:
- Not rubbing the wound
- Not bending or heavy lifting
- Sleeping with the head raised
- Avoid swimming, hot tubs, whirlpools and spas for a given period
- Apply ice packs to the area for 15 minutes every hour while awake, for a period of three days