PT  - JOURNAL ARTICLE
AU  - Alexis Khorrami Kashi
AU  - Chafik Keilani
AU  - Thien-Huong Nguyen
AU  - Pierre Keller
AU  - Sina Elahi
AU  - Jean-Marie Piaton
TI  - Dacryolithiasis diagnosis and treatment: a 25-year experience using nasal endoscopy
AID  - 10.1136/bjophthalmol-2021-319671
DP  - 2023 Feb 01
TA  - British Journal of Ophthalmology
PG  - 289--294
VI  - 107
IP  - 2
4099  - http://bjo.bmj.com/content/107/2/289.short
4100  - http://bjo.bmj.com/content/107/2/289.full
SO  - Br J Ophthalmol2023 Feb 01; 107
AB  - 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.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.