title: The Dacryocystorhinostomy Ostium Granulomas: Classification, Indications for Treatment, Management Modalities and Outcomes.
abstract: OBJECTIVE
  Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previously. This study aims to classify the DCR-related granulomas based on their ostial locations and to assess the outcomes of their management.
  
  
  METHODS
  A retrospective consecutive case series of 47 ostial granulomas evaluated over a period of 2 years were included in this study. All patients underwent detailed endoscopic examination to assess the granuloma locations and their response to initial topical steroids treatment. Persistent granulomas either underwent further management with excision or intralesional steroids based on their location. Patients were followed up for a minimum of 6 months. The primary outcome measure was resolution of granuloma.
  
  
  RESULTS
  The mean age at presentation was 45 years with a female preponderance (68%). 70% (33/47) of granulomas were following external DCR and 30% (14/47) occurred in the setting of endonasal DCR. The most common location was an edge granuloma in 46.8% (22/47) followed by a combined granuloma in 21.2% (10/47). 91.4% (43/47) underwent initial treatment with topical nasal steroids. The remaining 4 (8.5%) underwent primary excision. Among those treated with topical steroids (n = 43), 9.3% (4/43) underwent further treatment with intralesional triamcinolone. Overall, 4.2% (2/47) recurred in 6 weeks following resolution and were treated with excision.
  
  
  CONCLUSIONS
  We recommend routine endoscopic evaluation of all the DCR ostia. Detection of granulomas in early stages and appropriate management as per guidelines proposed may aid in better outcomes.
authors.affiliation: Dacryology Service, L. V. Prasad Eye Institute , Hyderabad , India and.
authors.forename: Mohammad Javed
authors.initials: MJ
authors.lastname: Ali
authors.forename: Peter John
authors.initials: PJ
authors.lastname: Wormald
authors.forename: Alkis James
authors.initials: AJ
authors.lastname: Psaltis
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003608:Dacryocystorhinostomy / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma / Q000145:classification / Q000209:etiology / Q000628:therapy; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000145:classification / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009301:Nasolacrimal Duct / Q000473:pathology*; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
keywords: DCR; granuloma; lacrimal; nasal endoscopy; ostium