J Korean Ophthalmol Soc.  2015 Sep;56(9):1454-1458. 10.3341/jkos.2015.56.9.1454.

A Case of Successful Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction with Wegener Granulomatosis

• Choi SH
• Lee MW
• Lee JJ
• Lee SB

• KMID: 2214563
• DOI: http://doi.org/10.3341/jkos.2015.56.9.1454

Abstract

PURPOSE
To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy.
CASE SUMMARY
A 36-year-old female diagnosed with Wegener's granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test.
CONCLUSIONS
Nasolacrimal duct obstruction occurring in a patient with Wegener's granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.

Keyword

Endoscopic dacryocystorhinostomy; External dacryocystorhinostomy; Nasolacrimal duct obstruction; Silastic sheet; Wegener's granulomatosis

MeSH Terms

Adult
Azathioprine
Dacryocystorhinostomy*
Female
Granuloma
Humans
Lacrimal Apparatus Diseases
Mucus
Nasal Cavity
Nasal Septum
Nasolacrimal Duct*
Silicones
Tears
Turbinates
Wegener Granulomatosis*
Rituximab
Azathioprine
Silicones

Figure

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  Figure 1. Left nasal cavity. The middle turbinate is not ob-served because of granuloma between the nasal septum and lateral wall.

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  Figure 2. Facial computed tomography. (A) Axial view. The dilated lacrimal sac enhanced by inflammation is seen on the lacrimal fossa (arrow). (B) Coronal view shows narrow nasal cavity filled with granulation tissue (arrowhead).

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  Figure 3. Dacryocystogram. It shows the small lacrimal sac with proximal nasolacrimal duct obstruction (arrow).

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  Figure 4. The nasal cavity at 5 months after surgery. Fluorescein dye flows well through the ostium.

Reference

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