COMPUTED-TOMOGRAPHY IN LACRIMAL OUTFLOW OBSTRUCTION

Background: Acquired nasolacrimal duct obstruction is a common ophthal mologic problem. Despite widespread understanding of treatments availa ble for nasolacrimal duct obstruction, few authors have commented on i ts etiology. Because the nasolacrimal system is anatomically related t o important nasal and sinus structures, the authors postulated that ac quired nasolacrimal duct obstruction and its complications might occur simultaneous to, and possibly as a consequence of, rhinologic or sinu s disease. Materials and Methods: Twenty-three patients with acquired nasolacrimal duct obstruction and 100 control patients were evaluated by coronal computed tomography for evidence of sinus disease or nasal abnormalities. Specifically, five findings were noted: ostiomeatal com plex disease, ethmoidal opacification, agger nasi cell opacification, concha bullosa, and nasal septal deviation. Results: Overall, 20 (87%) patients with acquired nasolacrimal duct obstruction demonstrated one or more radiologic finding of sinus disease or rhinologic abnormality whereas 63 (63%) control subjects exhibited these findings. This diff erence was determined to be statistically significant (P < 0.05). A st atistically significant higher incidence of ethmoidal opacification, a gger nasi cell opacification, and nasal septal deviation was observed in patients with nasolacrimal outflow obstruction than in controls. Di fferences in the incidence of ostiomeatal complex disease and concha b ullosa were not found to be statistically significant. Conclusion: The se data demonstrate a correlation between computed tomography findings of sinus disease or nasal abnormality and the presence of acquired na solacrimal outflow obstruction. This association between radiologic ev idence of sinorhinologic disorders and lacrimal outflow obstruction ma y imply that dacryocystitis, like sinus disease, may be produced by di sease of the lateral nasal wall. When evaluating a patient with acquir ed nasolacrimal duct obstruction, the physician should consider evalua tion for concomitant nasal and sinus disease.