Unexpected pathologies in patients referred for endoscopic DCR

Area of Science:

• Ophthalmology
• Otorhinolaryngology
• Radiology

Background:

• Nasolacrimal duct obstruction (NLDO) is a common condition causing epiphora.
• Endoscopic dacryocystorhinostomy (DCR) is a standard surgical treatment for NLDO.
• Preoperative imaging is crucial for surgical planning.

Purpose of the Study:

• To describe rare pathologies that mimic nasolacrimal duct obstruction (NLDO).
• To evaluate the role of computed tomography (CT) scans in diagnosing these mimickers before endoscopic dacryocystorhinostomy (DCR).
• To highlight how identifying these pathologies can alter patient management and surgical approach.

Main Methods:

• Retrospective review of 47 patients (57 sides) with long-standing epiphora diagnosed with NLDO.
• Analysis of pre-operative sinus CT scans for patients scheduled for endoscopic DCR.
• Review of demographic and medical characteristics, and surgical outcomes.

Main Results:

• Four patients (7% of sides) presented with unexpected pathologies mimicking NLDO.
• Identified pathologies included squamous cell carcinoma, rhinoscleroma, ethmoidal mucocele, and dacryocystocele.
• CT scans accurately identified these pathologies and their relation to the lacrimal apparatus.

Conclusions:

• Various nasal, paranasal, and lacrimal pathologies can present as primary acquired NLDO.
• A high index of suspicion and thorough clinical evaluation are essential.
• Preoperative CT imaging is vital for accurate diagnosis, altering management, and guiding surgical approach for suspected NLDO.