External dacryocystorhinostomy outcomes in sarcoidosis patients

To determine surgical outcomes after external dacryocystorhinostomy (DCR) surgery in patients with sarcoidosis.

We retrospectively reviewed the charts of all patients with sarcoidosis who underwent external DCR surgery between January 2001 and January 2010. Clinical data reviewed included patient demographics, immunosuppressive therapies, biopsy results, use of intraoperative triamcinolone, and postoperative outcomes and complications. Success was defined as resolution of epiphora.

External DCR was performed on 13 sides of 9 patients with sarcoidosis. Four patients were systemically immunosuppressed with methotrexate or plaquenil, and 4 patients used inhaled corticosteroids only. Intraoperative biopsy in 10 cases (9 patients) revealed non-necrotizing granulomatous inflammation (8 cases) and chronic inflammation (2 cases). Silicone stents were removed at a mean of 2.9 months. Initial DCR surgery was successful in 10 of 13 (87%) surgeries with an average follow up of 31 months (range, 14 to 48 months). None of the 5 surgeries (4 patients) with intralesional triamcinolone injections failed, compared with 3 of 8 (38%) surgeries without intralesional triamcinolone. Of the 3 failures, 2 early failures (3 months) were successfully treated with balloon catheter dilation. In the one patient with a late failure (47 months), subsequent balloon catheter dilation failed. All 3 patients who experienced failures used inhaled corticosteroids only. In contrast, 4 of the 6 patients with successful surgery were systemically immunosuppressed. Complications such as punctal erosion, wound necrosis, or cerebrospinal fluid leak did not occur.

External DCR surgery successfully treats nasolacrimal duct obstruction associated with sarcoidosis. Intralesional triamcinolone may improve the success rate without added complications. Long-term success may be less in patients not receiving systemic immunosuppressive therapy.