Excision of lacrimal sac (dacryocystectomy)
CPT4 code
Name of the Procedure:
Excision of lacrimal sac (dacryocystectomy)
Summary
In simple terms, an excision of the lacrimal sac, medically known as a dacryocystectomy, involves surgically removing a part of the tear sac. This procedure is typically done to treat chronic infections or blockages that affect the tear drainage system.
Purpose
Medical Condition: Chronic dacryocystitis or obstructions in the tear drainage system. Goals: To eliminate infection, restore normal tear drainage, and relieve symptoms like tearing, swelling, and discomfort.
Indications
Symptoms/Conditions: Persistent tearing (epiphora), recurrent infections of the lacrimal sac, or a confirmed blockage in the nasolacrimal duct. Patient Criteria: Patients with chronic dacryocystitis unresponsive to other treatments or those with structural abnormalities in the tear drainage system that warrant surgical intervention.
Preparation
Pre-Procedure Instructions: Patients may need to fast for 6-8 hours if general anesthesia is used. They should also disclose all medications and supplements to their doctor. Diagnostic Tests: Nasolacrimal duct imaging and assessment to confirm the blockage.
Procedure Description
- Anesthesia: Local anesthesia with sedation or general anesthesia is administered.
- Incision: A small incision is made near the inner corner of the eye.
- Dissection: The surgeon carefully dissects down to the lacrimal sac.
- Excision: The affected portion of the lacrimal sac is removed.
- Closure: The incision is sutured and covered with a sterile dressing.
Tools/Equipment: Scalpels, surgical scissors, retractors, sutures.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
This procedure is usually performed in a hospital or an outpatient surgical center.
Personnel
Healthcare Professionals: An ophthalmic surgeon, a surgical nurse, an anesthesiologist, and possibly a surgical assistant.
Risks and Complications
Common Risks: Bleeding, infection, scarring. Rare Risks: Damage to surrounding structures, persistent inflammation, or failure to resolve symptoms. Management includes antibiotics for infection or additional procedures if complications arise.
Benefits
Expected Benefits: Relief from chronic tearing and infections, improved quality of life. Realization: Benefits are usually noticeable within a few weeks post-surgery.
Recovery
Post-Procedure Care: Keep the incision area clean and dry, apply prescribed antibiotic ointments, and avoid strenuous activities. Expected Recovery Time: Most patients recover within 2 to 4 weeks. Restrictions/Follow-Up: Follow-up visits to monitor healing and ensure no complications.
Alternatives
Other Treatment Options: Conservative management with antibiotics, dacryocystorhinostomy (DCR), or balloon dacryoplasty. Pros and Cons: DCR may be preferred for less invasive tear drainage restoration, while balloon dacryoplasty is less extensive but not always effective for severe cases.
Patient Experience
During the procedure, patients under local anesthesia with sedation may feel minor pressure but typically no pain. Post-procedure, there may be mild discomfort or swelling managed with pain relief medications. The overall experience is generally well tolerated with adherence to post-care instructions ensuring smooth recovery.