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Incision and drainage of a lacrimal sac abscess

Usually, acute dacryocystitis can be treated conservatively with systemic antibiotics and warm compresses. The purpose of the warm compresses is to cause vasodilatation and increase delivery of the systemic antibiotic. If the patient fails conservative therapy, it is very reasonable to perform and incision and drainage of the lacrimal sac. The purpose of this is to not only release the abscess, but also to improve penetration of the antibiotic to the area. Often, the tissue is very tense, and penetration of the antibiotic is suboptimal. By releasing the abscess, the tissue tension is less, and presumably delivery of the systemic antibiotic is improved. The area should be packed for a couple days with iodoform gauze. There is some evidence that performing an endoscopic DCR in the setting of an acute dacryocystitis results in quicker recovery, and you are also fixing the underlying problem. This is Richard Allen at oculosurg.com. This video demonstrates and incision and drainage of a lacrimal sac abscess. Imaging shows the dilated lacrimal sac with an abscess that extends down the nasolacrimal duct. The area is anesthetized, which can sometimes be difficult due to the tight skin from the abscess. You don’t want to anesthetize directly into the sac, but around it. A 15 blade is then used to make an incision over the sac. In this case, the abscess is not as superficial as some. The incision should be about 1 cm in length. You can usually palpate the abscess and place your marking over that area. The blade should be directed posterior and medial. In this case, the incision needs to be made a little deeper than usually. At times you can hit the angular vessels (which you would like to avoid) resulting in brisk bleeding. Cotton tipped applicators are then used to express the contents of the sac. Purulent material is expressed. This should be sent for culture. A chalazion curette can then be used to disrupt any septations in the abscess to improve drainage. Iodoform gauze should then be used to pack the area which can be removed in approximately 2 days. Over 400 oculoplastic surgery videos are available, free of charge, here and at www.oculosurg.com