Purpose

To characterize the histopathological spectrum of lacrimal sac specimens obtained during external dacryocystorhinostomy (Ex-DCR) and evaluate association with clinical features and surgical outcomes in primary acquired nasolacrimal duct obstruction (PANDO).

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Methods

In this retrospective study, 87 patients undergoing Ex-DCR were evaluated, and a total of 93 lacrimal sac specimens were analyzed. During Ex-DCR, inferior lacrimal sac flaps were excised and submitted for histopathological examination, allowing detailed assessment of underlying structural and inflammatory changes. Demographic characteristics, history and frequency of dacryocystitis episodes, and postoperative irrigation outcomes were analyzed in relation to histopathological findings.

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Results

The mean age was 53.5 ± 14.3 with a female predominance (77.0 %). The left side was slightly more frequently affected (52.7 %). Most patients (72.1%) had no prior history of dacryocyctitis. Chronic nonspecific inflammation was the most common histopathological finding (92.5%), followed by vascular proliferation (17.2%), fibrosis (16.1%), and calcification (9.7%). IgG4 positivity was detected in 3 (3.2%) cases, and a significantly higher rate of previous dacryocystitis attacks was observed in IgG4-positive patients (66.4%) compared to other histopathological groups (p=0,04). Rare pathologies included actinomyces granuloma (n=1, 1.1%), reactive lymphoid hyperplasia (n=3, 3.2%), and fibroepithelial polyp (n=1, 1.1%). The overall postoperative success rate was 93.1%.

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Conclusion

Although nonspesific chronic inflammation represents the predominant histopathological pattern in PANDO, routine histopathological evaluation of lacrimal sac specimens may reveal critically significant and unsuspected entities such as IgG4-related disease and lymphoproliferative disorders. These findings support the role of routine sampling in facilitating early diagnosis of underlying systemic or localized conditions.

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Additional Authors

First name	Last name	Base Hospital / Institution
Mehmet Emre	Usta	Karadeniz Technical University, Faculty of Medicine, Department of Public Health, Trabzon, Turkiye
Elif	Ozmen Usta	Trabzon University, Faculty of Medicine, Department of Ophthalmology, Kanuni Training and Research Hospital, Trabzon, Turkiye
Bartu	Gannemoglu	University of Health Sciences, Ankara Bilkent City Hospital, Ophthalmology Department, Ankara, Turkiye
Nilay	Yuksel	University of Health Sciences, Ankara Bilkent City Hospital, Ophthalmology Department, Ankara, Turkiye

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