title: Dacryolith in an unusual case of epiphora: open or endoscopic approach?
abstract: BACKGROUND
  Dacryoliths are concretions formed in the lacrimal sac from cellular debris and proteins, which may calcify and cause further obstruction of the nasolacrimal pathway. Dacryoliths are often underlying contributors in cases of intermittent or chronic dacryocystitis (i.e. nasolacrimal sac inflammation, characterised by epiphora, pain, erythema, sac dilation and lacrimal punctum swelling).
  
  
  OBJECTIVE
  We report an unusual case of dacryolith resulting in obstructive epiphora, managed via an endonasal endoscopic approach.
  
  
  METHODS
  Case report and literature review pertaining to dacryolith.
  
  
  RESULTS
  A 54-year-old man attended the multidisciplinary nasolacrimal clinic due to recurrent epiphora. Obstructive epiphora secondary to chronic dacryocystitis was diagnosed. He underwent endonasal endoscopic dacryocystorhinostomy. Intra-operatively, a large dacryolith was found to be the cause of epiphora.
  
  
  CONCLUSIONS
  Dacryolith is an unusual cause of nasolacrimal duct obstruction. This case highlights this unusual cause, and the relevant diagnostic investigations. This case also illustrates successful endonasal endoscopic management, rather than an external, open approach.
authors.affiliation: Department of ENT, Royal Bolton NHS Trust, UK. chai32@yahoo.com
authors.forename: C
authors.initials: C
authors.lastname: Gadepalli
authors.forename: V
authors.initials: V
authors.lastname: Malik
authors.forename: C
authors.initials: C
authors.lastname: Inkster
authors.forename: C
authors.initials: C
authors.lastname: Lobo
mesh_terms: D002137:Calculi / Q000150:complications / Q000601:surgery*; D002908:Chronic Disease; D003608:Dacryocystorhinostomy / Q000379:methods*; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D011859:Radiography; D012008:Recurrence; D015607:Stents