title: Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis.
abstract: OBJECTIVE
  To evaluate the outcomes of endonasal dacryocystorhinostomy (EN-DCR) surgery in patients with sarcoidosis.
  
  
  METHODS
  Retrospective chart review of all patients with sarcoidosis undergoing EN-DCR in 6 practices from 1999-2011.
  
  
  RESULTS
  We included 18 procedures in 14 patients (8 female, 6 male) who underwent EN-DCR for acquired NLDO secondary to sarcoidosis. The mean age was 53.7 (range 38-82). The presenting symptom in all cases was epiphora. Eight patients (57%) complained of having additional nasal congestion. Surgery was performed using endoscopic powered-type DCR with flaps in 12/18 (67%) and non-endoscopic mechanical EN-DCR in 6/18 (33%). In 15 (83%) cases the lacrimal sac and nasal mucosa appeared abnormally yellowish, crusty, oedematous and friable. Five patients were treated with pre-operative oral steroid and overall 8 patients had oral prednisolone post operatively, 30-60 mg tapered within 10 days-8 weeks. One patient had difficulties in tapering down the oral steroids at 6 months of follow-up. All patients were free of epiphora and patent to syringing, with nasal endoscopy revealing free flow of fluorescein through the ostium at a mean follow-up of 11.3 months (median follow-up 9 months).
  
  
  CONCLUSIONS
  All 18 cases of acquired nasolacrimal duct obstruction secondary to sarcoidosis were treated successfully with EN-DCR. An abnormal appearance of the nasal mucosa is an important sign. Nasal congestion is a frequent sign. A successful outcome may not depend on intensive long-term therapy with local or systemic steroids. Mechanical or powered EN-DCR for nasolacrimal duct obstruction secondary to sarcoidosis achieves encouraging medium-term outcomes.
authors.affiliation: Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, United Kingdom.
authors.forename: Inbal
authors.initials: I
authors.lastname: Avisar
authors.forename: Alan A
authors.initials: AA
authors.lastname: McNab
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dolman
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Patel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Desousa
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.forename: Raman
authors.initials: R
authors.lastname: Malhotra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003608:Dacryocystorhinostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007767:Lacrimal Duct Obstruction / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000601:surgery; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications*; D016896:Treatment Outcome