title: Nasolacrimal tuberculosis: case report highlighting the need for imaging in identifying and managing it effectively.
abstract: OBJECTIVE
  To report a rare case of nasolacrimal tuberculosis, conduct a literature review, and to suggest an optimal management plan.
  
  
  METHODS
  A 39-year old Zimbabwean female presented with a 3-year history of left epiphora, haemolacria and medial canthal mass. On ophthalmic examination there was no lateral displacement of the left globe. The initial management was external dacryocystorhinostomy. Histology of the biopsy was inconclusive and her symptoms did not improve. This prompted a referral to otolaryngology. Nasal examination revealed a friable mass of the middle turbinate. CT scan showed paranasal sinus and lacrimal sac destruction and lateral displacement of the globe. Endoscopic sinus surgery confirmed the CT findings, allowed a biopsy taken, and the histology showed prominent caseating granulomatous inflammation. Microbiological cultures confirmed nasolacrimal tuberculosis.
  
  
  CONCLUSIONS
  We report a case of primary tuberculosis affecting the nasolacrimal apparatus presenting with a medial canthal mass. This report highlights the need for high index of suspicion, and initial CT imaging in order to avoid invasive procedures such as external dacryocystorhinostomy, which may cause extra surgical morbidity and delay diagnosis and treatment.
authors.affiliation: Department of Otorhinolaryngology, St George's Hospital Medical School, University of London, London, UK. ljablenska@doctors.org.uk
authors.forename: Liliana
authors.initials: L
authors.lastname: Jablenska
authors.forename: Stephen
authors.initials: S
authors.lastname: Lo
authors.forename: Jimmy
authors.initials: J
authors.lastname: Uddin
authors.forename: Abbad
authors.initials: A
authors.lastname: Toma
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004724:Endoscopy; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy; D009301:Nasolacrimal Duct / Q000000981:diagnostic imaging*; D011718:Pyrazinamide / Q000627:therapeutic use; D011736:Pyridoxine / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014392:Tuberculosis, Ocular / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D004338:Drug Combinations; C087181:isoniazid, pyrazinamide, rifampin drug combination; D011718:Pyrazinamide; D004977:Ethambutol; D011736:Pyridoxine; D007538:Isoniazid; D012293:Rifampin