References 103
Fig. 6.8 Wegener granulomatosis involving the lacrimal sac (case F). (a) A 70-year-old male with a history of Wegener granulomatosis presenting with bilateral epiphora and recurrent dacryocystitis for 8 months. (b) Histopathologic section (hematoxylin and eosin, original magnification ×100) demonstrating granulomatous inflammation compatible with an active stage of Wegener granulomatosis
Fig. 6.9 Sarcoidosis involving the lacrimal sac (case G). (a) Persistent epiphora and dacryocystitis 12 months following bilateral endonasal DCR in a 65-year-old female with a history of sarcoidosis. (b) Histopathologic section (hematoxylin and eosin, original magnification ×100) revealing granulomatous inflammation with “naked granulomas” (arrows) compatible with active sarcoidosis
Summary for the Clinician
■Clinical symptoms and signs as well as the history of predisposing systemic diseases may raise suspicion of significant lacrimal sac pathologies requiring further medical or surgical intervention.
■In addition, external DCR allows an excellent possibility for inspection of the lacrimal sac and for adequate tissue biopsy of abnormal-appearing findings.
■Selective lacrimal sac biopsy for atypical clinical or intraoperative findings allows early diagnosis and management of life-threatening lesions affecting the lacrimal drainage system.
References
1.Anderson NG, Wojno TH, Grossniklaus HE (2003) Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy. Ophthal Plast Reconstr Surg 19:173–176
2.Bartley GB (1992) Acquired lacrimal drainage obstruction: an etiologic, classification system, case reports and a review of the literature. Part 1. Ophthal Plast Reconstr Surg 8: 237–242
3.Bernardini FP, Moin M, Kersten RC, Reeves D, Kulwin DR (2002) Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy. How useful is it? Ophthalmology 109:1214–1218
104 |
6 Clinicopathologic Features of Lesions A ecting the Lacrimal Drainage System |
4.Boboridis KG, Bunce C, Rose GE (2005) Outcome of external dacryocystorhinostomy combined with membranectomy of a distal canalicular obstruction. Am J Ophthalmol 139: 1051–1055
65. Emmerich KH, Busse H, Meyer-Rüsenberg HW (1994) Dacryocystorhinostomia externa. Technique, indications and results [in German]. Ophthalmologe 91:395–398
6.Font RL (1996) Eyelids and lacrimal drainage system. In: Spencer WH (ed) Ophthalmic pathology, vol 4. Saunders, Philadelphia, pp 2412–2427
7.Heindl LM, Jünemann A, Holbach LM (2008) A clinicopathologic study of nasal mucosa in 350 patients with external dacryocystorhinostomy. Orbit 27(6):462–465
8.Heindl LM, Jünemann A, Holbach LM (2008) Lacrimal drainage system. In: Naumann GOH, Holbach L, Kruse FE (eds) Applied pathology for ophthalmic microsurgeons. Springer, Berlin, pp 45–48
9.Heindl LM, Schick B, Kämpgen E, Kruse FE, Holbach LM (2008) Malignant melanoma of the lacrimal sac [in German]. Ophthalmologe 105(12):1146–1149. (Epub ahead of print)
10.Kottler UB, Schlötzer-Schrehardt U, Holbach LM (2004) Epiphora and conjunctivitis for 6 years [in German]. Ophthalmologe 101:730–732
11.Lee-Wing MW, Ashenhurst ME (2001) Clinicopathologic analysis of 166 patients with primary acquired nasolacrimal duct obstruction. Ophthalmology 108:2038–2040
12.Linberg JV, McCormick SA (1986) Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology 93:1055–1063
13.Mauriello JA, Palydowycz S, DeLuca J (1992) Clinicopathologic study of lacrimal sac and nasal mucosa in 44 patients
with complete acquired nasolacrimal duct obstruction. Ophthal Plast Reconstr Surg 8:13–21
14.McNab AA (1994) Manual of orbital and lacrimal surgery. Churchill Livingstone, Edinburgh, pp 75–86
15.Merkonidis C, Brewis C, Yung M, Nussbaumer M (2005) Is routine biopsy of the lacrimal sac wall indicated at dacryocystorhinostomy? A prospective study and literature review. Br J Ophthalmol 89:1589–1591
16.Olver J (2002) Colour atlas of lacrimal surgery. Butterworth Heinemann, Oxford, pp 94–114, 158–162
17.Parmar DN, Rose GE (2003) Management of lacrimal sac tumours. Eye 17:599–606
18.Pe’er JJ, Stefanyszyn M, Hidayat AA (1994) Nonepithelial tumors of the lacrimal sac. Am J Ophthalmol 118:650–865
19.Stefanyszyn MA, Hidayat AA, Pe’er JJ, Flanagan JC (1994) Lacrimal sac tumors. Ophthal Plast Reconstr Surg 10: 169–184
20.Thale A, Paulsen E, Rochels R, Tillmann B (1998) Functional anatomy of the human efferent tear ducts: a new theory of tear outflow mechanism. Graefes Arch Clin Exp Ophthalmol 236:674–678
21.Traquair HM (1941) Chronic dacryocystitis. Its causation and treatment. Arch Ophthalmol 26:165–180
22.Tucker N, Chow D, Stockl F, Codère F, Burnier M (1997). Clinically suspected primary acquired nasolacrimal duct obstruction. Clinicopathologic review of 150 patients. Ophthalmology 104:1882–1886
23.Valenzuela AA, McNab AA, Selva D, O’Donell BA, Whitehead KJ, Sullivan TJ (2006) Clinical features and management of tumors affecting the lacrimal drainage apparatus. Ophthal Plast Reconstr Surg 22:96–101