[Lacrimal sac tumors presenting as lacrimal obstruction. Retrospective study in Mexican patients 2007-2012]

Timing of Jones Tube Placement After Excision of Nasal or Lacrimal Drainage System Malignancy: A Survey of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)

Purpose

To elicit, from a survey of oculoplastic surgeons, the timing and reason for delaying Jones tube placement after the excision of nasal or lacrimal drainage system malignancy.

Methods

The authors reviewed current literature and distributed an anonymous survey to 627 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) to determine the length of time members wait to perform a Jones tube placement after the removal of nasal or lacrimal drainage system malignancy. The survey also included questions about the rationale for this waiting period.

Results

Fifty-eight members of ASOPRS (9.3%) responded to our survey, 49 (84.4%) of whom had performed Jones tube placement on patients who had an excision of a nasal or lacrimal drainage system malignancy. Nearly 52% of respondents waited one year for Jones tube placement. However, a sizeable number of respondents opted to wait five years (15.1%). The most common rationale for waiting was a concern for tumor recurrence (42 responses).

Conclusion

There is no consensus on when to perform Jones tube placement after the excision of nasal or lacrimal drainage system malignancy. This survey demonstrates a broad array of waiting periods between operations, although most surgeons wait 12 months.

[Masquerade lacrimal duct stenosis: prevalence of lacrimal sac tumors]

BACKGROUND

Tumors of the lacrimal sac are a rare entity. Malignancies are often associated with a high mortality rate. Lacrimal sac tumors often present as lacrimal duct stenosis with dacryocystitis and are often only diagnosed after an intraoperative biopsy. The aim of this study was a retrospective analysis of all cases with lacrimal sac tumors, which presented with a lacrimal duct stenosis at this medical center in the past 10 years.

METHODS

All patients who were treated by external dacryocystorhinostomy (DCR) at the University Medical Center Münster during the period January 2009-December 2018 were retrospectively analyzed for the presence of a lacrimal sac tumor. Symptoms, clinical and histopathological findings, diagnostic and therapeutic procedures as well as long-term follow-up were analyzed.

RESULTS

A total number of 878 patients underwent an external DCR at the University Medical Center Münster during the study period. Of these patients 13 were diagnosed with a lacrimal sac tumor and included 9 malignant lymphomas, 2 squamous cell carcinomas, 1 oncocytic adenoma and 1 transitional cell papilloma.

CONCLUSION

Neoplasms of the lacrimal sac can masquerade as lacrimal duct stenosis or dacryocystitis and must be considered as a differential diagnosis in cases with an atypical clinical course. A lacrimal sac biopsy during an (external) DCR with subsequent histopathological examination is strongly recommended in such cases.