Purpose: To elucidate the clinical characteristics, preoperative tests, and treatment outcomes of lacrimal sac dacryolith
Methods: We conducted our investigation based on the medical records of 307 sides in 245 patients with nasolacrimal duct obstruction who underwent endoscopic nasolacrimal duct intubation or dacryocystorhinostomy (DCR) at the Ehime University Hospital Department of Ophthalmology from 2008 to 2015. With regard to the questionnaire survey of patient background and subjective symptoms, we compared the group with dacryolithiasis against the group without the condition, and examined lacrimal irrigation testing, lacrimal duct endoscopy, cone-beam computed tomography (CBCT) dacryocystography, and treatment in the group with dacryolithiasis.
Results: The group with dacryolithiasis consisted of 23 sides in 23 patients, with a mean age of 65.6 years. The mean disease duration was 25.3 months, and 4 sides had a history of acute dacryocystitis. A questionnaire survey of subjective symptoms conducted preoperatively revealed no statistically significant difference in all items among the 9 sides in the group with dacryolithiasis and the 63 sides in the group without dacryolithiasis. The results of lacrimal irrigation testing were as follows: 20 sides with obstruction, 2 sides without obstruction, and 1 side with unknown findings. CBCT dacryocystography was performed in 4 sides in whom dacryolithiasis was delineated as filling defects. The treatment consisted of endoscopic nasolacrimal duct intubation with dacryolith surgical removal in 21 sides with a mean of 1.29 sessions, and in all patients, a lacrimal duct tube was inserted. DCR was performed in 2 sides.
Conclusions: Lacrimal sac dacryolithiasis complications occur in approximately 7.5% of nasolacrimal duct obstructions and carry a high risk of acute dacryocystitis. Lacrimal duct endoscopy is useful for the diagnosis and treatment, and CBCT dacryocystography might also be beneficial for the diagnosis.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 523-529, 2021.