Endonasal Dacryocystorhinostomy for Nasolacrimal Duct Obstruction in Patients with Sarcoidosis. (August 2013)

• Record Type: Journal Article
• Authors: Avisar, Inbal; McNab, Alan A.; Dolman, Peter J.; Patel, Bhupendra; deSousa, Jean-Louis; Selva, Dinesh; Malhotra, Raman
• Is Part Of: Orbit. Volume 32:Number 4(2013)
• Page Start: 225
• Page End: 230
• Publication Date: 2013-08
• Subjects: Eye-sockets -- Surgery -- Periodicals; Eye-sockets -- Diseases -- Periodicals; Orbit -- surgery -- Periodicals; Orbital Diseases -- Periodicals; 617.7
• DOI: 10.3109/01676830.2013.788670
• Languages: English
• ISSNs: 0167-6830

Abstract

<abstract> <title>Abstract</title> <p> <italic>Purpose</italic>: To evaluate the outcomes of endonasal dacryocystorhinostomy (EN-DCR) surgery in patients with sarcoidosis.</p> <p> <italic>Methods</italic>: Retrospective chart review of all patients with sarcoidosis undergoing EN-DCR in 6 practices from 1999–2011.</p> <p> <italic>Results</italic>: 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).</p> <p> <italic>Conclusions</italic>: 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.</p> </abstract>