Bicanalicular Obstruction in Lichen Planus: A Characteristic Pattern of Disease
Received 21 March 2006; received in revised form 8 March 2007; accepted 10 March 2007.
Purpose
Lichen planus, an idiopathic mucocutaneous inflammatory disease, has only once been reported to cause lacrimal drainage obstruction. The authors present a series of patients with epiphora resulting from systemic lichen planus and describe the characteristic pattern of lacrimal canalicular blockage.
Design
Retrospective noninterventional case series.
Participants
Eight patients (5 women, 3 men) with a median presenting age of 49 years (range, 39–60 years).
Methods
A retrospective review of case notes for patients attending the lacrimal clinic between 1998 and 2005 was performed to identify patients with nontraumatic lacrimal canalicular obstruction. In addition to demographic information, the data collected included a history of periocular herpetic infection, administration of systemic 5-fluorouracil, other causes of canalicular obstruction, the extent of proximal and distal canalicular obstruction (noted during surgery), the type of surgery, and the surgical outcomes.
Main Outcome Measures
Identification of patients with biopsy-proven systemic lichen planus who had conjunctival and canalicular disease and documentation of the extent and severity of canalicular obstruction.
Results
Of the 184 patients with canalicular obstruction identified during the study period, 8 had lichen planus. Bilateral, bicanalicular involvement was present in 7 of 8 lichen planus patients, with 3 of 8 patients having completely obstructed canaliculi. Primary dacryocystorhinostomy (DCR) with retrograde canaliculostomy was performed in 4 of 8 patients, but all required secondary placement of Lester Jones canalicular bypass tubes. The other 4 patients had either primary DCR alone (both eyes in 1 patient, with solely canalicular stenosis) or DCR with primary placement of Jones tubes (6 eyes in 3 patients). Histologic examination of pericanalicular tissues in 2 patients showed features consistent with lichen planus.
Conclusions
Lacrimal involvement in lichen planus is characterized by severe bilateral bicanalicular occlusion involving most of the length of affected canaliculi, and placement of a Jones canalicular bypass tube is generally required to control symptoms.
ABSTRACT