From Epiphora to Surgical Intervention: Unraveling a Lacrimal Obstruction Case
Author: Nima Sadeghi
Base Hospital / Institution: UZ Brussel
ePoster presentation
Abstract ID: 25-409
Purpose
To describe the diagnostic and surgical management of a 66-year-old Caucasian male presenting with a one-year history of right-sided epiphora due to a suspected obstructive lacrimal lesion, ultimately requiring endonasal intervention.
Methods
The patient presented with progressive right-sided epiphora over a year. No prior trauma or infection was noted. Initially diagnosed with ectropion, he was referred to our service. Examination revealed a subconjunctival reddish caruncular lesion with yellow discoloration over the punctum, while the rest of the eye appeared normal. The Anel test showed a soft stop with saline irrigation, and lacrimal probing confirmed non-patent canaliculi, suggesting complete nasolacrimal obstruction.
Results
Imaging revealed complete obstruction of the right nasolacrimal duct by a mass originating from the meatus media, with infiltration along the medial orbital margin. Given these findings, the patient underwent endonasal dacryocystorhinostomy and septoplasty to restore lacrimal drainage, nasal anatomy and for tumor biopsy.
This showed cylindric mucosa with chronic inflammation and storiform fibrosis, most suggestive for IgG4 disease. Postoperatively, anatomical correction was achieved, and bi-canalicular intubation confirmed successful lacrimal passage reconstruction.
Conclusion
Epiphora can result from simple obstruction or expansive lesions requiring advanced imaging. Initially suspected as ectropion, this case highlights the need for thorough ophthalmologic and radiologic evaluation.
Imaging revealed nasolacrimal duct encasement and anatomical disruptions, guiding surgical management. Biopsy findings suggested IgG4-related disease, a systemic fibroinflammatory condition affecting multiple organs, including the eyes. Early recognition is crucial for considering immunomodulatory therapy.
Successful treatment required collaboration between oculoplastic and otolaryngology specialists, demonstrating the importance of interdisciplinary expertise and histopathologic assessment in diagnosing complex lacrimal obstructions.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Ine | Lambert | UZ Brussel |
