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Updated: Jun 15, 2025

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction
Published on: October 13, 2017
Leprosy as a cause of nasolacrimal duct obstruction
Darren A Chen1, Maxwell T Roth2, Firas Sbeih3
1Ophthalmic Plastic Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Abstract:
Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery.
Insights
Leprosy (Hansen disease) can cause late-onset eye complications like nasolacrimal duct obstruction. This case shows granulomatous inflammation in the lacrimal sac, a rare sequela of treated Mycobacterium leprae infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pathology
Background:
- Leprosy, or Hansen disease, is caused by Mycobacterium leprae and can affect the skin, nerves, and eyes.
- While treated, leprosy can have long-term sequelae, including ocular complications.
Purpose of the Study:
- To report a case of epiphora due to chronic nasolacrimal duct obstruction as a late complication of treated tuberculoid leprosy.
- To describe the pathological findings in the lacrimal sac.
Main Methods:
- Endoscopic dacryocystorhinostomy (DCR) was performed.
- Histopathological examination of the lacrimal sac specimen was conducted.
- Fite staining was used to identify bacterial structures.
Main Results:
- The patient presented with epiphora four years post-treatment for leprosy.
- Dacryocystitis with granulomatous inflammation and bacterial structures was found in the lacrimal sac.
- Pathology revealed non-necrotizing granulomas consistent with sequelae of M. leprae infection.
Conclusions:
- Chronic nasolacrimal duct obstruction can be a delayed manifestation of treated leprosy.
- Granulomatous inflammation in the lacrimal sac is a potential sequela of M. leprae infection.
- Surgical intervention (DCR) can effectively manage this complication.
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