Purpose

to report a case of a bilateral Nasolacrimal Duct Obstruction (NDO) associated with Cocaine-Induced Midline Destructive Lesions (CIMDL) successfully treated by endonasal dacryocystorhinostomy (DCR)

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Methods

first documentation of a case of bilateral NDO associated with CIMDL

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Results

62-year-old patient complaining of bilateral epiphora with repeated left acute dacryocystitis. The irrigation of the lacrimal system shows a complete nasolacrimal obstruction, bilaterally. The dacryoscanner confirms nasolacrimal obstruction, proximal on the right side, distal on the left side, associated with a large destruction of the nasal fossae. The nasofibroscopy shows a septal perforation with complete destruction of the inferior turbinates. Patient reports an anterior chronic use of cocaine. A bilateral DCR is realised by nasal endoscopy with intubation (video associated). No surgical complication is reported and functional results are excellent at 6 months of follow-up. The biopsy of the nasal mucosa shows a lympho-plasmocytic inflammatory infiltrate.

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Conclusion

Ophthalmic impacts of chronic use of cocaine are overlooked. Cocaine induces a large range of ophthalmic presentations, from
angle closure to orbital cellulitis with pseudotumor. It must also be part of the differential diagnosis in the NDO. When induced but cocaine, NDO need a full anatomical assessment of the orbits and sinuses. The management is in tight collaboration with ENT.

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Additional Authors

First name	Last name	Base Hospital / Institution
Natasha	Mambour	Hopital Fondation Rothschild
E	Langlois	Hopital Fondation Rothschild
Mathieu	Veyrat	Hopital Fondation Rothschild
Pierre-Vincent	Jacomet	Hopital Fondation Rothschild
Olivier	Galatoire	Hopital Fondation Rothschild

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