A 55-year-old woman presents with a 3-week history of painful swelling over the right medial canthus, epiphora, and purulent discharge from the punctum on pressure over the lacrimal sac. The most appropriate definitive treatment once the acute infection resolves is:
- A Dacryocystorhinostomy (DCR) ✓
- B Dacryocystectomy
- C Balloon dacryoplasty
- D Silicone intubation
Correct answer: A. Dacryocystorhinostomy (DCR)
Explanation
Acute dacryocystitis with chronic mucocele formation results from obstruction of the nasolacrimal duct. Once the acute infection is controlled with antibiotics, dacryocystorhinostomy (DCR) is the definitive treatment, creating a fistula between the lacrimal sac and nasal mucosa. Dacryocystectomy sacrifices the lacrimal pump and causes permanent epiphora. Balloon dacryoplasty and silicone intubation are used for partial or proximal obstructions, not for established nasolacrimal duct obstruction with mucocele.
Reference: AAO BCSC Section 7: Orbit, Eyelids, and Lacrimal System, 2022-2023 ed.
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Written and medically reviewed by the StethoPrep medical team.