Lacrimal Excretory System Concretions: Canalicular and Lacrimal Sac
Received 7 November 2008; received in revised form 10 April 2009; accepted 15 April 2009. published online 10 September 2009.
Purpose
To characterize the demographics of patients with dacryolithiasis and to compare patients who have canalicular concretions with patients who have lacrimal sac and duct dacryoliths.
Design
Comparative case series study and literature review.
Participants
A total of 327 consecutive patients undergoing external dacryocystorhinostomy (DCR) between 1998 and 2008 at the University of Wisconsin-Madison. Fifteen consecutive patients with the diagnosis of canaliculitis during this period were also included.
Methods
The charts of all patients were reviewed for age, sex, laterality, duration of symptoms, history of dacryocystitis, history of lacrimal system intervention, history of smoking, examination findings, result of canalicular probing and irrigation, and histopathologic evaluation of the dacryolith or canalicular concretion. If applicable, the canaliculus involved was noted, as was any history of purulent canalicular drainage or canalicular injury.
Main Outcome Measures
Patient demographics, duration of symptoms, history of dacryocystitis, history of smoking, presence of fungi, or Actinomyces on histopathologic evaluation. Findings were compared with prior studies reported in the literature.
Results
Of the 327 patients undergoing DCR, 22 (6.7%) had dacryoliths; 11 of 15 patients (73.3%) with canaliculitis had canalicular concretions. Patients with canalicular concretions were older than those with dacryoliths at DCR: 70.6 years versus 51.1 years (P = 0.003). Women made up the majority of both groups: 9 of 11 patients (81.8%) with canalicular concretions and 13 of 22 patients (59.1%) with dacryoliths at DCR (P = 0.26). The mean duration of symptoms was 20.2 months among patients with canalicular concretions and 30.5 months in patients with dacryoliths at DCR (P = 0.66); 1 of 11 patients (9.1%) with canalicular concretions smoked, compared with 9 of 21 patients (42.9%) with dacryoliths at DCR (P = 0.11). Actinomyces was isolated from 10 of 11 canalicular concretions (90.9%) and only 3 of 22 dacryoliths (13.6%) from DCR (P<0.001). In none of the 11 canalicular concretions were fungi identified, compared with 2 of 22 dacryoliths (9.1%) from DCR (P = 0.54).
Conclusions
The demographics of patients with dacryoliths and the histopathology of their concretions vary with the location of the dacryolith in the lacrimal excretory system.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: September 10, 2009.
1University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
2Oculoplastics Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin
Correspondence: Cat N. Burkat, MD, Oculoplastics Service, Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, F4/344 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792
Manuscript no. 2008-1325.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the Vincent Springer Oculoplastics Fund and in part by an unrestricted grant to the Department of Ophthalmology and Visual Sciences by Research To Prevent Blindness, Inc., New York, New York.
ABSTRACT