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Dacryolithiasis diagnosis and treatment: a 25-year experience using nasal endoscopy
  1. Alexis Khorrami Kashi1,
  2. Chafik Keilani2,
  3. Thien-Huong Nguyen3,
  4. Pierre Keller1,
  5. Sina Elahi4,
  6. Jean-Marie Piaton1
  1. 1Department IV, Endoscopic Endonasal Surgery and Oculoplastic Division, National Hospital Centre for Ophthalmology Quinze-Vingts, Paris 75012, France
  2. 2Department II of Ophthalmology, National Hospital Centre for Ophthalmology Quinze-Vingts, Paris 75012, France
  3. 3Department of Neuro-Imaging, National Hospital Centre for Ophthalmology Quinze-Vingts, Paris 75012, France
  4. 4Department of Ophthalmology, Fondation Rothschild, Paris 75019, France
  1. Correspondence to Dr Alexis Khorrami Kashi, Department IV, Endoscopic Endonasal Surgery and Oculoplastic Division, National Hospital Centre for Ophthalmology Quinze-Vingts, Paris, Île-de-France, France; alexis.khorrami{at}gmail.com

Abstract

Background Dacryolith-induced epiphora is caused by a chronic obstruction of the nasolacrimal duct whose aetiology is often specified peroperatively. Dacryocystorhinostomy (DCR) has been often regarded as the gold standard to treat dacryolithiasis. Hasner’s valve (HV) incision is a technique to evacuate lithiasis through its physiological track. The purpose of this study was to describe clinical and radiological findings associated with presence of dacryoliths in patients who underwent surgery and to assess the efficacy of these two procedures.

Methods This study was a comparative interventional multicentric retrospective study including patients referred for an epiphora. The primary endpoint was to determine clinical and endoscopic findings associated with dacryoliths. The secondary endpoints were to evaluate the performance of CT dacryocystography (CT-DG) in the diagnosis of dacryoliths and the success rate of the surgical treatment 6 months postoperatively.

Results 4677 nasolacrimal ducts (NLDs) (78.0% female, mean age 59.2) were included in the study. 3913 underwent DCR, and 764 underwent HV incision. 291 out of 4677 NLDs (6.2%) were found to have dacryoliths. Presence of mucocele associated to a permeable lacrimal system (OR 8.17 (95% 4.62 to 14.44), p<0.01) was associated with presence of lithiasis peroperatively. Success rates at 6 months were 95.6% for endonasal DCR and 94.6% for incision of HV in dacryolithiasis group (p<0.01). CT-DG had a negative predictive value of 96.3% to detect lithiasis (p<0.01).

Conclusion Strong clinical and endoscopic findings may improve the imputability of dacryoliths in epiphora. Evacuation of dacryolithiasis through its physiological track was first described in this study in adults with similar results to DCR in patients presenting with dacryolithiasis.

  • eye lids
  • lacrimal drainage
  • orbit
  • tears

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data are all deidentified; they are available only from Dr Jean Marie Piaton in an Excel form.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data are all deidentified; they are available only from Dr Jean Marie Piaton in an Excel form.

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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