Nasolacrimal duct obstruction: clinicopathologic analysis of 205 cases.
OBJECTIVE
To investigate the histopathological results of lacrimal sac biopsies in patients with primary acquired nasolacrimal duct obstruction.


METHODS
In this prospective non-comparative study, 205 consecutive patients, who were diagnosed as primary acquired nasolacrimal duct obstruction, were included. Patients with history of trauma and/ or surgery in the periorbital area, punctum or canalicular obstruction were excluded from the study. Patients were evaluated for age, gender, history, and presenting symptoms. Lacrimal drainage system abnormalities were assessed. Lacrimal system irrigation, dacryocystography, and in selected cases dacryoscintigraphy was performed. All patients underwent external dacryocystorhinostomy. Biopsy specimens were obtained from the posterior inferior flap and examined by the same pathologist.


RESULTS
Forty-seven male and 158 females with age ranging from 6 to 81 years (mean 47.5 ± 16.2 years) were included in the study. Only one patient had the diagnosis of chronic leukemia, others had no preexisting history of systemic disease. Pathologic examination revealed chronic inflammation (n= 178), fibrosis without inflammation (n= 19), normal mucosa (n= 4), and lymphoid hyperplasia (n= 1). Three patients had abnormal pathology: Lymphoproliferative disease in the patient with chronic leukemia, granulomatous inflammation, and basosquamous cell carcinoma.


CONCLUSIONS
In primary nasolacrimal duct obstruction, pathological examination of the lacrimal sac revealed chronic inflammatory changes in most patients. Even though rare, malignant or systemic disease in patients with neither specific history nor clinical or radiological finding might be observed in these cases. Thus, we recommend taking biopsy if any suspicion of abnormality of the lacrimal sac exists.
Altan-Yaycioglu
Rana
R
Faculty of Medicine, Department of Ophthalmology, Baskent University, Yuregir, Adana 01250, Turkey. raltanya@yahoo.com
Canan
Handan
H
Sizmaz
Selcuk
S
Bal
Nebil
N
Pelit
Aysel
A
Akova
Yonca A
YA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D003608:Dacryocystorhinostomy; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000175:diagnosis; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D055815:Young Adult