Abstract
BackgroundAcquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. However, cases exist where the primary nasolacrimal system obstruction is caused by malignancies.Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and compare their clinical manifestations.MethodsThis retrospective clinical study included 275 patients with acquired nasolacrimal duct obstruction who underwent external dacryocystorhinostomy and lacrimal sac biopsy. Cases were classified into tumor or nonspecific pathology groups and subdivided according to the level of inflammation. Histological and clinical data were analyzed.ResultsThree tumors (1.1%) (an adenoid cystic carcinoma, an eccrine spiradenoma and small B cell lymphoma) were diagnosed. Chronic nongranulomatous inflammation was the most common histological finding, corresponding to 194 cases (70.5%). The other 81 (29.5%) were subacute, acute forms of nongranulomatous inflammation, tumors and fibrosis cases. Epiphora with continuous purulent discharge was the most common clinical sign reported by 144 (52.4%) patients, and two (0.7%) patients had a palpable mass near the medial canthal tendon, which was identified as an eccrine spiradenoma and small B cell lymphoma. There was no significant difference in the clinical symptoms, duration or case history between the nonspecific pathology and tumor groups (p = 0.292).ConclusionsChronic nongranulomatous inflammation of the lacrimal sac was the most common finding among acquired nasolacrimal duct obstruction cases. There were no associations between the histological findings and clinical presentation. The authors recommend a lacrimal sac biopsy only in cases when a tumor is clinically suspected.
Highlights
Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct
There were no associations between the histological findings and clini‐ cal presentation
Acquired nasolacrimal duct obstruction (ANDO) is a common disease of the lacrimal passages that is most frequently caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct, resulting in occlusive fibrosis [1, 2]
Summary
Acquired nasolacrimal duct obstruction is a blockage of the lacrimal outflow system usually caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct. Cases exist where the primary nasolacrimal system obstruction is caused by malignancies. Our aim was to investigate lacrimal sac pathologies in patients with acquired nasolacrimal duct obstruction and com‐ pare their clinical manifestations. Acquired nasolacrimal duct obstruction (ANDO) is a common disease of the lacrimal passages that is most frequently caused by local nonspecific inflammation of the lacrimal sac and the nasolacrimal duct, resulting in occlusive fibrosis [1, 2]. Secondary causes of ANDO include lacrimal sac neoplasia, inflammatory diseases, specific infections, mechanical obstruction, and trauma [3]. Other researchers recommend biopsies only in select cases in which there is clinical or intraoperative suspicion of a tumor because unsuspected tumors causing ANDO are relatively rare, with an incidence ranging from 0 to 7.1% [9,10,11,12]
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