Dacryocystectomy: surgical indications and results in 25 patients.

The main indication for dacryocystectomy (DCT) is excision of lacrimal sac tumors. DCT may be considered less invasive than dacryocystorhinostomy (DCR) because lacrimal bone and nasal mucosa are not violated. To determine other indications for DCT, we performed a retrospective review of all patients who underwent DCT from the Oculoplastics Division, Department of Ophthalmology, UMD-New Jersey Medical School from July 1983 through July 1994. Patients with lacrimal sac tumors were excluded from the study. All 25 patients in the study demonstrated complete nasolacrimal duct obstruction (NLDO) and dry eye with minimal preoperative complaints of tearing. Nine of 25 patients also had systemic medical problems making them at medical risk for local anesthesia with monitored sedation. Four of 25 patients had underlying medical conditions (ocular cicatricial pemphigoid [OCP], Crohn's disease, and systemic lupus erythematosus) that might predispose them to nasal scarring after standard DCR. None of the 25 patients required secondary hospital admission and no patient demonstrated or complained of significant tearing that affected daily function after DCT. Although DCR is the standard for improving lacrimal outflow, we conclude that DCT is a useful alternative to it in selected patients with underlying dry eye and other medical conditions.