Lacrimal Obstruction in Inflammatory Bowel Disease

External Versus Endoscopic Endonasal Dacryocystorhinostomy

DCR is the treatment of choice for NLDO. External DCR has remained the standard approach since the 1890s. With advances in technique and technology, and more otolaryngologists and ophthalmologists performing endoscopic DCR, more studies have been conducted, some with equivalent success rates between the 2 approaches. Endoscopic endonasal DCR offers the advantages of avoiding a skin incision with similar success rates with experienced surgeons. However, the technique necessitates more surgical equipment, and has a steep learning curve. Both approaches have low complication rates and serious complications are very rare. The decision for the type of approach to use depends on the surgeon’s experience, the patient’s preference or concerns, and the resources available within a particular health system.

External dacryocystorhinostomy outcomes in patients with a history of dacryocystitis

PURPOSE

To investigate nonidiopathic causes of external dacryocystorhinostomy (DCR) failure.

METHODS

The medical records of all patients with acute or chronic dacryocystitis who underwent external dacryocystorhinostomy performed by the senior author over a 5-year period were retrospectively reviewed, with attention to microbiology, pathology, and associated medical and history.

RESULTS

A total of 52 lacrimal systems of 49 patients were included, with a minimum follow-up of 2 months (average, 15.5 months). Surgical success was achieved in 42 systems (87%). Of 7 failures, 6 had a condition potentially associated with an increased risk of failure, including MRSA infection, Gram-negative infection, rhinosinusitis, lymphoma, inflammatory bowel disease, and early loss of lacrimal stents.

CONCLUSIONS

External DCR is a successful procedure for the treatment of nasolacrimal obstruction associated with dacryocystitis. Various factors may affect surgical success, and awareness of these factors may enable better patient counseling and surgical planning.

Extraintestinal Crohn disease causing bilateral nasolacrimal duct obstruction

A 16-year-old boy presented with complaints of epiphora and bilateral palpably distended lacrimal sacs. He had a history of Crohn disease involving the small and large intestines, and a history of granulomatous cheilitis. Bilateral dacryocystorhinostomies were performed through an external approach and revealed multiple nodular masses in both lacrimal sacs, which on biopsy, contained granulomatous inflammation consistent with extraintestinal Crohn disease. A literature search from 1966 to the present using the PubMed database revealed three previous publications describing nasolacrimal duct obstruction associated with Crohn disease, but these cases did not show pathologic evidence of granulomatous inflammation. To our knowledge, this is the first reported case of extraintestinal Crohn disease with granulomatous inflammation affecting the lacrimal-outflow system.