Lacrimal sac dacryoliths - Predictive factors and clinical characteristics

Objective: Lacrimal sac dacryoliths are often diagnosed during dacryocystor hinostomy (DCR), although their cause is unclear. Several factors have been suggested to predispose to dacryolith formation, The clinical presentation of nasolacrimal duct obstruction (NLDO) may differ if associated with a da cryolith. Our study evaluated specific risk factors related to dacryolith f ormation and how the clinical presentation of patients with dacryoliths dif fers from patients with primary acquired NLDO who undergo DCR. Design: Retrospective, comparative, interventional case series. Participants/intervention: One hundred thirty-eight consecutive patients wi th NLDO who underwent DCR (163 total DCR cases) between 1993 and 1998. Main Outcome Measures: We evaluated the frequency of dacryolith formation f or all DCR cases. For 115 patients with primary acquired NLDO, we statistic ally compared the patients with dacryoliths (n = 12) to those without (n = 103) for several variables related to clinical history and presentation. Results: The overall frequency of dacryoliths was 12 of 163 (7.4%) for all DCR cases and 12 of 138 (8.7%) for all patients. All patients with dacryoli ths were in the subgroup of 115 patients with primary acquired NLDO, and th e frequency in that subgroup was 12 of 115 (10.4%), There was no statistica l difference between the group of patients with dacryoliths and those witho ut dacryoliths for age, duration of epiphora, history of acute dacryocystit is, or previous use of antiglaucomatous topical medications. Male gender wa s more likely to be associated with dacryoliths (P = 0.004), as was initial presentation with lacrimal sac distension (P < 0.001), Partial nasolacrima l obstruction on lacrimal irrigation approached statistical significance fo r dacryolith formation (P = 0.08), as did a history of cigarette smoking (P = 0.09). Conclusions: In patients with primary acquired NLDO who require DCR, male g ender and presence of sac distension are more frequently associated with da cryoliths, Partial NLDO and history of cigarette smoking may also be relati ve risk factors for dacryolith formation. These observations may be helpful in the evaluation and surgical planning for patients with lacrimal obstruc tion. Ophthalmology 2001;108:1308-1312 (C) 2001 by the American Academy of Ophthalmology.