Pison A, Fau J-L, Racy E, Fayet B
Hôpital Hôtel-Dieu, 1, parvis Notre-Dame - place Jean-Paul-II, 75004 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
Cabinet privé, 30, place Carriere, 54000 Nancy, France.
J Fr Ophtalmol. 2016 Oct;39(8):687-690. doi: 10.1016/j.jfo.2016.03.009. Epub 2016 Aug 29.
The formation of a fistula between the lacrimal sac and the skin is a classic outcome of resistant lacrimal sac abscesses. There is currently no consensus about treatment in such cases. The goal of this study was to describe the natural history of acquired fistulas between the lacrimal sac and the skin, occurring before planned endonasal dacryocystorhinostomy (DCR) and without any treatment of the fistula.
This prospective study was only descriptive and included patients between 1999 and 2012. The patients included were adults with a nasolacrimal duct (NLD) obstruction that was planned to be treated with endonasal DCR. A resistant lacrimal sac abscess appeared a few days before the planned surgery, and fistulized spontaneously despite medical treatment. The surgery was not delayed. The DCR was endoscopic. Nothing was done for the fistula. Its healing was spontaneous. The exclusion criteria were the following: congenital fistulas, post-traumatic and/or iatrogenic fistulas, fistulas which had regressed by the day of the surgery, postoperative follow-up less than 5 months, post-traumatic and/or iatrogenic fistulas, any history of previous DCR or any other lacrimal surgery, children.
Twenty adults (25 cases) were included in the analysis. Mean age was 79 years old (from 41 to 90). The mean follow-up was 41 months (from 5 to 108 months). The fistula spontaneously disappeared in all cases, less than one month after it had appeared and in a permanent fashion. No unsightly scar developed.
Spontaneously acquired fistulas between the lacrimal sac and the skin may occur in the natural course of abscessed acute dacryocystitis. Our study showed spontaneous healing of the fistula post-endoscopic DCR.
Fistula excision in fistulous acute dacryocystitis does not seem essential to its healing. The laisser-faire approach appears adequate for aesthetic outcomes as well as for functional outcomes of DCR.
泪囊与皮肤之间形成瘘管是泪囊脓肿经久不愈的典型后果。目前对于此类病例的治疗尚无共识。本研究的目的是描述在计划进行鼻内泪囊鼻腔造口术（DCR）之前出现且未对瘘管进行任何治疗的后天性泪囊与皮肤之间瘘管的自然病程。
这项前瞻性研究仅为描述性研究，纳入了1999年至2012年期间的患者。纳入的患者为计划接受鼻内DCR治疗的鼻泪管（NLD）阻塞的成年人。在计划手术前几天出现了经久不愈的泪囊脓肿，尽管进行了药物治疗，但仍自发形成了瘘管。手术未延迟。DCR为内镜手术。未对瘘管进行任何处理。其愈合是自发的。排除标准如下：先天性瘘管、创伤后和/或医源性瘘管、手术当天已消退的瘘管、术后随访少于5个月、创伤后和/或医源性瘘管、既往有DCR或任何其他泪道手术史、儿童。
20名成年人（25例）纳入分析。平均年龄为79岁（41至90岁）。平均随访时间为41个月（5至108个月）。所有病例中的瘘管均在出现后不到1个月内自发且永久性地消失。未形成难看的瘢痕。
泪囊与皮肤之间的自发后天性瘘管可能发生在急性泪囊炎脓肿的自然病程中。我们的研究显示内镜下DCR术后瘘管可自发愈合。
瘘管性急性泪囊炎中的瘘管切除似乎对其愈合并非必不可少。放任疗法对于DCR的美学效果以及功能效果似乎都是足够的。
