Abstract
Purpose:To evaluate the role of viral infections in the pathogenesis of primary acquired nasolacrimal duct obstruction.Methods:The study included 48 patients diagnosed with primary acquired nasolacrimal duct obstruction undergoing dacryocystorhinostomy surgery. Prior to dacryocystorhinostomy surgery, nasal swab sample was taken from the inferior meatus at the same side. During dacryocystorhinostomy, tissue biopsy sample (2 × 2 mm) was taken from the junction area of the lacrimal sac and nasolacrimal duct. Following nucleic acid extraction, polymerase chain reaction was performed.Results:The patients consisted of 9 (18.8%) men and 39 (81.2%) women with a mean age of 51.0 ± 14.3 years. Qualitative polymerase chain reaction showed viral genome in the nasal swabs of 10 (20.8%) patients, including coronavirus 229E (three cases), coronavirus HKU1 (two cases), respiratory syncytial virus (two cases), coronavirus OC43 (one case), coronavirus NL63 (one case), and adenovirus (one case). In the dacryocystorhinostomy samples, viral genomes were detected in four (8.3%) cases, including respiratory syncytial virus (two cases), coronavirus HKU1 (one case), and adenovirus (one case). There was a statistically significant agreement between nasal mucosal swab and dacryocystorhinostomy biopsy samples in terms of respiratory syncytial virus positivity (kappa = 1.000, p = 0.001).Conclusion:Although the viral genome was detected in the samples, a direct relationship between viruses and pathogenesis of primary acquired nasolacrimal duct obstruction could not be revealed because of the low number of positive results. However, considering the profibrotic characteristics of specific viruses such as respiratory syncytial virus and adenovirus, viral infections may be one of the many predisposing factors of primary acquired nasolacrimal duct obstruction.
Highlights
Primary acquired nasolacrimal duct obstruction (PANDO) is the most common cause of epiphora in adults.[1]
Viral infections have been reported as the possible trigger factors in the pathogenesis of several diseases, such as idiopathic pulmonary fibrosis, dilated cardiomyopathy, and arrhythmogenic right ventricular dysplasia, characterized by inflammation and secondary fibrosis in their histopathological examinations.[7,8,9,10]
The exact mechanisms leading to chronic inflammation and secondary fibrosis, which are the predominant findings of the PANDO histopathology,[2,3,4] have not yet been elucidated
Summary
Primary acquired nasolacrimal duct obstruction (PANDO) is the most common cause of epiphora in adults.[1] A variety of anatomical, endocrine, environmental, and socioeconomic risk factors have been suggested in the etiology; the precise pathogenesis of PANDO has not yet been elucidated. PANDO has been reported to be able to occur secondary to unrecognized low-grade dacryocystitis.[5] In one experimental model of dacryocystitis, the number of collagen fibers and fibrocytes in the lamina propria had increased 3 months after a Staphylococcus aureus inoculation.[6] Viruses, as superior to Recently, viral infections have been reported as the possible trigger factors in the pathogenesis of several diseases, such as idiopathic pulmonary fibrosis, dilated cardiomyopathy, and arrhythmogenic right ventricular dysplasia, characterized by inflammation and secondary fibrosis in their histopathological examinations.[7,8,9,10] A similar mechanism may be possible for the pathogenesis of PANDO which has common histopathological characteristics with these diseases
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