title: Lacrimal dacryostenosis with severe facial pain misdiagnosed as trigeminal neuralgia.
abstract: A 47-year-old woman developed intermittent shooting pain around the right side of the nose and eyes. A neurologist initially diagnosed trigeminal neuralgia, but carbamazepine did not improve the pain. Two months later, she presented with a pus-like eye discharge and was referred to us for further examination. Poor saline irrigation from the lacrimal puncta and computed tomography findings of a swollen lacrimal sac indicated a diagnosis of lacrimal dacryostenosis. At this point, the pain and dizziness as a side effect of carbamazepine had become intolerable. Endoscopic intranasal dacryocystorhinostomy confirmed stenosis of the nasolachrymal duct and a thickened lacrimal sac. The postoperative course was uneventful, and the facial pain disappeared. This experience suggests the importance of recognizing lacrimal dacryostenosis as a differential diagnosis of facial pain around the eyes and nose. We also recommend a review of an original diagnosis of trigeminal neuralgia if carbamazepine fails to relieve facial pain.
authors.affiliation: Department of Otolaryngology, Aichi Medical University, Aichi, Japan; Department of Otolaryngology, Tohno-Kousei Hospital, Gifu, Japan. tanigawa@aichi-med-u.ac.jp
authors.forename: Tohru
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kaneda
authors.forename: Tessei
authors.initials: T
authors.lastname: Kuruma
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ueda
mesh_terms: D003608:Dacryocystorhinostomy; D003951:Diagnostic Errors; D005157:Facial Pain / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007767:Lacrimal Duct Obstruction / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014277:Trigeminal Neuralgia / Q000175:diagnosis*