Elsevier

Ophthalmology

Volume 109, Issue 7, July 2002, Pages 1214-1217
Ophthalmology

Routine histopathologic evaluation of the lacrimal sac during dacryocystorhinostomy: how useful is it?

https://doi.org/10.1016/S0161-6420(02)01082-5Get rights and content

Abstract

Objective

To determine the usefulness of “routine” lacrimal sac biopsy to evaluate unsuspected neoplasm or systemic disease in patients with acquired nasolacrimal duct obstruction.

Design

Noncomparative, interventional case series with histopathologic correlation.

Participants

Review of charts revealed histopathologic reports on 302 specimens from 258 patients who had undergone routine dacryocystorhinostomy for clinical acquired nasolacrimal duct obstruction.

Intervention

Dacryocystorhinostomy (DCR) with histopathologic evaluation of lacrimal sac.

Main outcome measures

The following variables were extracted from the medical records: age, gender, presenting symptoms, history of predisposing conditions, lacrimal system abnormalities noted before surgery, dye disappearance test, dacryocystogram or dacryoscintillogram, appearance of the lacrimal sac during surgery, and histopathologic report of the lacrimal sac specimen.

Results

Findings of histopathologic evaluation of 302 lacrimal sac specimens from 170 females and 88 males who had undergone routine DCR were reviewed. Evidence of systemic disease or neoplasia involving the lacrimal sac was present in 10 specimens. All 10 positive specimens had a grossly abnormal appearing sac at the time of surgery (n = 8), a known preexisting history of systemic diseases (n = 6), or both. The remaining 292 specimens showed chronic inflammation, fibrosis, or normal mucosa.

Conclusions

Only patients with known preexisting systemic disease or a grossly abnormal lacrimal sac had “positive” histopathologic findings. We recommend that lacrimal sac biopsy in patients undergoing DCR should be performed only in those with a positive history for systemic disease or an abnormal-appearing lacrimal sac during surgery.

Section snippets

Materials and methods

Three hundred two lacrimal sac biopsies obtained from 258 patients (44 bilateral cases) who underwent DCR for presumed primary acquired NLDO from 1988 through 1999 at the University of Cincinnati- and Cincinnati Eye Institute-affiliated facilities were reviewed retrospectively. Preoperative assessment of the lacrimal drainage system included history for predisposing conditions, inspection, palpation, digital expression of lacrimal sac contents, dye disappearance test with 2% fluorescein, and

Results

A total of 302 DCRs were performed for acquired NLDO on 258 patients. Of these 258 patients, 170 (66%) were females and 88 (34%) were males, with an average age of 61.3 years (range, 10–95 years). Twenty-two patients had bilateral surgery and 236 had unilateral surgery. Dacryocystitis was present in 91 patients (30%) in either acute or chronic form. History of nasal trauma was present in 19 patients (6.3%).

The patients were divided into two groups on the basis of history and clinical

Discussion

The incidence of unsuspected lacrimal sac pathologic features at the time of DCR has been reported to be between 0% and 12.5%. Several authors have recommended that routine histopathologic evaluation of the lacrimal sac be performed in all patients undergoing surgery to correct primary acquired NLDO. However, routine histopathologic evaluation is expensive, with surgical pathologic charges ranging from $250 to $480 for each surgical specimen reviewed in this study.

Bartley,4, 5, 6 in his

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