PURPOSE: To evaluate the frequency of acquired lacrimal sac fistula formation after incision and drainage for dacryocystitis and to determine associated risk factors. METHODS: National multicenter retrospective study of acquired lacrimal sac fistula formation in patients receiving incision and drainage during the course of treatment for dacryocystitis between January 2005 and December 2007. Data collection included patient demographics, past medical history, procedure technique, culture results, and details of the medical and surgical management. The formation of a persistent fistula was ascertained, in addition to the subsequent treatment of the dacryocystitis. RESULTS: Thirty-nine patients from 9 centers were included. Reasons cited for performing incision and drainage included a tense, pointing abscess, severe pain not relieved with narcotics, periorbital cellulitis, dacryocystitis refractory to antibiotics alone, and the need to control infection prior to dacryocystorhinostomy. In 33 of 39 patients (84.6%), incision and drainage and associated medical treatment cured the dacryocystitis. Only 2 of 39 patients (5.1%) developed a persistent fistula following incision and drainage. No risk factors of statistical significance were identified. Dacryocystorhinostomy to correct associated nasolacrimal duct obstruction was subsequently performed in 36 of 39 (92.3%). CONCLUSIONS: Incision and drainage of the lacrimal sac can be an appropriate adjunctive treatment strategy for selected cases of dacryocystitis. Incision and drainage provides appropriate culture media, symptomatic pain relief, and can facilitate resolution. In this series, persistent lacrimal sac fistula formation after incision and drainage and associated medical and surgical treatment for dacryocystitis was rare.
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