Endonasal dacryocystorhinostomy for nasolacrimal duct obstruction in patients with sarcoidosis.

Abstract

PURPOSE:

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: Inbal Avisar, Alan A McNab, Peter J Dolman, Bhupendra Patel, Jean-Louis Desousa, Dinesh Selva, Raman Malhotra
• Journal: Orbit (Amsterdam, Netherlands) (Orbit) Vol. 32 Issue 4 Pg. 225-30 (Aug 2013) ISSN: 1744-5108 [Electronic] England
• PMID: 23662621 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adult
• Aged
• Aged, 80 and over
• Dacryocystorhinostomy (methods)
• Female
• Humans
• Lacrimal Duct Obstruction (etiology)
• Male
• Middle Aged
• Nasolacrimal Duct (surgery)
• Retrospective Studies
• Sarcoidosis (complications)
• Treatment Outcome