Abstract
Primary acquired nasolacrimal duct obstruction (PANDO) is an idiopathic narrowing of the nasolacrimal duct caused by chronic inflammation and consecutive stenosis of the nasal tissue. In the current investigation, we aimed to study the etiopathogenic role of sinonasal anatomical abnormalities and paranasal inflammatory pathologies in PANDO. Computed tomography (CT) findings of 459 patients who were diagnosed with unilateral PANDO between April 2009 and March 2017 were compared with that of a control group, which comprised 200 subjects without nasolacrimal duct obstruction who had been referred to the ear nose throat (ENT) clinic with the complaint of vertigo and headache. A radiologist (R. S.) masked to the clinical situation of participants retrospectively examined their CT findings. The prevalence of deviated nasal septum was found to be strongly associated with PANDO incidence (55.3% on PANDO side of patients vs. 28.3% among controls; p<0.001). Significant increases, albeit of smaller magnitude, were also observed in the relative frequency of Agger nasi cells and maxillary sinusitis on the PANDO side of the subjects (14.6% and 27.0%, respectively) compared to controls (9.5% and 20.6%, respectively) (p=0.023 and p=0.038, respectively). Unilateral PANDO was also found to be robustly associated with an ipsilateral deviated nasal septum (p<0.001). The odds of septal deviation occurrence were 3.037 times (95% Confidence Interval (CI): 2.303-3.990; p<0.001) more on the PANDO than the non-PANDO side of the studied cases. Ipsilaterally deviated nasal septum appears to have a role in the development of unilateral primary acquired obstructive disease of the lacrimal drainage system. The incidence of PANDO might also be affected by Agger nasi cells and maxillary sinusitis. Multicenter studies are essential to further elucidate the interaction between type, severity, extent, and dimensions of different pathologies with nasolacrimal duct obstruction.
Highlights
Primary acquired nasolacrimal duct obstruction (PANDO) is a syndrome caused by chronic inflammation and consecutive stenosis of tear duct that predominantly affects adult female patients and presents with excessive tearing or epiphora
Materials and Methods: Computed tomography (CT) findings of 459 patients who were diagnosed with unilateral PANDO between April 2009 and March 2017 were compared with that of a control group, which comprised 200 subjects without nasolacrimal duct obstruction who had been referred to the ear nose throat (ENT) clinic with the complaint of vertigo and headache
The prevalence of deviated nasal septum was found to be strongly associated with PANDO incidence (55.3% on PANDO side of patients vs. 28.3% among controls; p0.001)
Summary
Primary acquired nasolacrimal duct obstruction (PANDO) is a syndrome caused by chronic inflammation and consecutive stenosis of tear duct that predominantly affects adult female patients and presents with excessive tearing or epiphora. Conjunctival infections, menstrual and hormonal fluctuation, sinusitis, eye-irritating make-up, female gender, smoking, history of dacryocystitis, and topical chloramide exposure are among the presumed predisposing factors for PANDO [2,3,4,5]. Due to the proximity of paranasal sinuses and the nasolacrimal duct, it has long been believed that abnormalities in sinonasal cavities might play a role in the production of nasolacrimal duct obstruction (NLDO) [6, 7]. We retrospectively reviewed sinonasal pathologies diagnosed by computed tomography (CT) in patients with unilateral PANDO. The prevalence of anatomical, inflammatory, and infectious abnormalities observed in the obstructed side of the PANDO
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