2019 Volume 112 Issue 12 Pages 795-800
Dacryocystorhinostomy is now a well established surgery for chronic dacryocystitis and nasolacrimal duct obstruction with high success rate. However, when the refractory purulent discharge continues after a dacryocystorhinostomy, a dacryocystectomy can be one of the therapeutic options to stop the discharge. We herein report on a case of successful management with antibiotic ointment injection into the lacrimal sac for refractory chronic dacryocystitis with methicillin-resistant Staphylococcus aureus after a primary dacryocystorhinostomy.
A seventy-four year-old woman was referred to our hospital with purulent discharge from the right eye, ophthalmalgia, and visual disturbance. Computed tomography-dacryocystography showed a right nasolacrimal duct obstruction. She was diagnosed as having right chronic dacryocystitis with a corneal ulcer by an ophthalmologist. The bacterial culture of the discharge revealed methicillin-resistant Staphylococcus aureus. The endoscopic dacryocystorhinostomy was performed by an otorhinolaryngologist with the assistance of the ophthalmologist. One month after the operation, the purulent discharge recurred from the operated side and it was refractory regardless of removal of the lacrimal stent and conservative treatment with antibiotic eye drops and an iodine eye drop. To stop the discharge, which continued at one week after the administration of vancomycin ophthalmic ointment, we tried vancomycin ophthalmic ointment injection therapy into the lacrimal sac from inferior lacrimal punctum. The injection was done once a day, and continued for six days. After the therapy, the purulent discharge stopped and the rhinostomy could be seen clearly.
We presume that either the long retention of vancomycin ophthalmic ointment or the high local concentration of vancomycin in the lacrimal sac were the reasons for the success of this injection therapy.
