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Lacrimal sac mucocele
  1. Suresh Sagili1,
  2. Caroline M H Thaung2,
  3. Raman Malhotra3
  1. 1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK;
  2. 2Department of Pathology, UCL Institute of Ophthalmology, London, UK;
  3. 3Corneo-Plastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, UK
  1. Correspondence to Raman Malhotra, Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK; raman{at}ramanmalhotra.com

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Case

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).

Figure 1

Swelling in the medial canthal area (arrow showing lacrimal sac mass).

Figure 2

Lacrimal sac wall with a dense stromal lymphoid infiltrate (H&E, ×4 objective). Inset: High power view demonstrating centrocyte-like morphology (H&E, ×40 objective).

Questions (For answers see below)

  1. What does the histological appearance show (figure 2)?

  2. What clinical features are suggestive of a lacrimal sac tumour?

  3. What investigations can be performed when suspecting a lacrimal sac tumour?

  4. What are the management …

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