CLINICALLY SUSPECTED PRIMARY ACQUIRED NASOLACRIMAL DUCT OBSTRUCTION -CLINICOPATHOLOGICAL REVIEW OF 150 PATIENTS

Purpose: The incidence of lacrimal sac pathology in patients with clin ically suspected primary acquired nasolacrimal duct obstruction is unk nown; This is an important issue when considering the potential risk o f either conservative nonsurgical management or laser dacryocystorhino stomy, neither of which permits direct visualization and biopsy of the lacrimal outflow apparatus. Methods: A total of 162 lacrimal sac biop sy specimens were obtained in 150 consecutive patients undergoing exte rnal or endonasal dacryocystorhinostomy for clinical primary acquired nasolacrimal duct obstruction from January 1992 to October 1994, Resul ts: A total of 147 patients (98%) had histopathologic findings consist ent with inflammation or fibrosis of the lacrimal sac or both, In the remaining three patients, abnormalities included sarcoid granuloma (on e patient), oncocytoma (one patient), and lymphoma (one patient). Conc lusions: The incidence of significant pathology of the lacrimal sac in clinically suspected primary acquired nasolacrimal duct obstruction i s low. However, these cases can be identified correctly only by routin e biopsy of the lacrimal sac during dacryocystorhinostomy.