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An 84-year-old Caucasian lady was referred to the clinic with a 4-month history of a non-tender right medial canthal swelling (figure 1). This was associated with initial soreness and discharge only. There was no associated epiphora. Her systemic medications included aspirin and calcium supplements. Visual acuity was 6/7.5 in each eye. Clinical examination was suggestive of right chronic dacryocystitis with a non-regurgitating mucocele. Probing demonstrated a complete obstruction at the level of common canaliculus on the right side with regurgitation of saline from upper punctum on syringing. The left lacrimal drainage system was patent on syringing. Endoscopic endonasal examination was normal. Dacryocystography or lacrimal scinitigram was not performed. A diagnosis of encysted mucocele secondary to chronic dacryocystitis was made. She was advised to undergo dacryocystectomy (DCT) under local anaesthesia as she did not have symptoms of epiphora. The excised lacrimal sac was sent for histological examination (figure 2).
What does the histological appearance show (figure 2)?
What clinical features are suggestive of a lacrimal sac tumour?
What investigations can be performed when suspecting a lacrimal sac tumour?
What are the management options?
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