Computed Tomography in Lacrimal Outflow Obstruction

Abstract

Acquired nasolacrimal duct obstruction is a common ophthalmologic problem. Despite widespread understanding of treatments available for nasolacrimal duct obstruction, few authors have commented on its etiology. Because the nasolacrimal system is anatomically related to important nasal and sinus structures, the authors postulated that acquired nasolacrimal duct obstruction and its complications might occur simultaneous to, and possibly as a consequence of, rhinologic or sinus disease. Twenty-three patients with acquired nasolacrimal duct obstruction and 100 control patients were evaluated by coronal computed tomography for evidence of sinus disease or nasal abnormalities. Specifically, five findings were noted: ostiomeatal complex disease, ethmoidal opacification, agger nasi cell opacification, concha bullosa, and nasal septal deviation. Overall, 20 (87%) patients with acquired nasolacrimal duct obstruction demonstrated one or more radiologic finding of sinus disease or rhinologic abnormality whereas 63 (63%) control subjects exhibited these findings. This difference was determined to be statistically significant (P < 0.05). A statistically significant higher incidence of ethmoidal opacification, agger nasi cell opacification, and nasal septal deviation was observed in patients with nasolacrimal outflow obstruction than in controls. Differences in the incidence of ostiomeatal complex disease and concha bullosa were not found to be statistically significant. These data demonstrate a correlation between computed tomography findings of sinus disease or nasal abnormality and the presence of acquired nasolacrimal outflow obstruction. This association between radiologic evidence of sinorhinologic disorders and lacrimal outflow obstruction may imply that dacryocystitis, like sinus disease, may be produced by disease of the lateral nasal wall. When evaluating a patient with acquired nasolacrimal duct obstruction, the physician should consider evaluation for concomitant nasal and sinus disease.