External Dacryocystorhinostomy in Patients with Systemic Sarcoidosis

Abstract

Sarcoidosis is an idiopathic systemic disorder characterized by noncaseating granulomas 1 Avisar I. McNab A.A. Dolman P.J. et al. Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis. Orbit. 2013; 32: 225-230 Crossref PubMed Scopus (13) Google Scholar that affects the nose and sinuses in up to 2%. 2 Lee B.J. Nelson C.C. Lewis C.D. Perry J.D. External dacryocystorhinostomy outcomes in sarcoidosis patients. Ophthalmic Plast Reconstr Surg. 2012; 28: 47-49 Crossref PubMed Scopus (14) Google Scholar Published outcomes for lacrimal drainage surgery in such patients are limited to small series from multiple centers using various techniques. 1 Avisar I. McNab A.A. Dolman P.J. et al. Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis. Orbit. 2013; 32: 225-230 Crossref PubMed Scopus (13) Google Scholar , 2 Lee B.J. Nelson C.C. Lewis C.D. Perry J.D. External dacryocystorhinostomy outcomes in sarcoidosis patients. Ophthalmic Plast Reconstr Surg. 2012; 28: 47-49 Crossref PubMed Scopus (14) Google Scholar , 3 Chapman K.L. Bartley G.B. Garrity J.A. Gonnering R.S. Lacrimal bypass surgery in patients with sarcoidosis. Am J Ophthalmol. 1999; 127: 443-446 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar We present a retrospective review of the clinical outcome for 75 external dacryocystorhinostomy procedures performed in 47 patients with systemic sarcoidosis in whom pulmonary disease was the most common manifestation (Table S1, available at www.aaojournal.org). Fifteen of 47 patients had been referred with failed prior dacryocystorhinostomy. Surgery was performed at Moorfields Eye Hospital, largely by a single surgeon (G.E.R.) using a uniform external dacryocystorhinostomy, with a large osteotomy, sutured posterior and anterior mucosal anastomoses, and placement of silicone intubation. 4 Verity D.H. Rose G.E. External dacryocystorhinostomy. in: Albert D.M. Lucarelli M.J. Clinical Atlas of Procedures in Ophthalmic and Oculofacial Surgery. Oxford University Press, Oxford2012: 1021-1032 Google Scholar Some of the patients underwent biopsy of nasal or sac tissues. These results were reported elsewhere, with granulomas present in 60% of sac biopsy samples and 87% nasal tissues. 5 Stewart C.M. Luthert P.J. Rose G.E. Nasal and lacrimal sac histopathology in patients with systemic sarcoidosis undergoing external lacrimal drainage surgery. Ophthalmic Plast Reconstr Surg. 2018 Sep 18; ([Epub ahead of print])https://doi.org/10.1097/IOP.0000000000001217 Google Scholar Systemic immunosuppression was unchanged, and all patients received postoperative steroid antibiotic eyedrops for a month; no nasal medication or douching was used. Sutures were removed at 7 to 10 days after surgery, intubation removed at between 4 and 6 weeks after surgery, and success was defined as resolution of epiphora. The study received institutional research board approval (identifier, CA17/AD/13) from Moorfields Eye Hospital. All research adhered to tenets of the Declaration of Helsinki, and all subjects consented to surgery and clinical follow-up.