Kapil Mishra1, Karen Y Hu, Saurabh Kamal, Aleza Andron, Robert C Della Rocca, Mohammad Javed Ali, Akshay Gopinathan Nair. 1. *Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.; †ProAdnexa Oculoplasty Solutions, Faridabad, Haryana, India; ‡Ophthalmic Plastic, Orbital, and Reconstructive Surgery, New York Eye & Ear Infirmary of Mount Sinai, New York, New York, U.S.A.; §Department of Ophthalmology, Mount Sinai West Hospital & Mount Sinai St. Luke' s Hospital, New York, New York, U.S.A.; ‖Institute of Dacryology, L V Prasad Eye Institute, Hyderabad, India; ¶Ophthalmic Plastic Surgery & Ocular Oncology Services, Advanced Eye Hospital & Institute, Navi Mumbai, Maharashtra, India; and #Department of Ophthalmology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India.
Abstract
PURPOSE: To review and summarize the clinical features, presentations, diagnostic modalities and management of dacryolithiasis. METHODS: A comprehensive PubMed search of all English articles on dacryolithiasis was reviewed. Although this review primarily relied on articles written in English, non-English-language articles that had abstracts translated into English were also reviewed. Data reviewed included epidemiology, pathogenesis, appearance and composition, clinical features, presentations, diagnostic modalities, management of dacryolithiasis and the implications of incidental dacryoliths found during lacrimal surgery. RESULTS: Although an unknown proportion of dacryolithiasis cases may remain asymptomatic; epiphora, acute and/or recurrent dacryocystitis, punctal discharge, and localized swelling are the most common presenting features of dacryolithiasis. It may also present as partial nasolacrimal duct obstruction. Dacryoliths exhibit a variety in external appearances. While some minimally invasive techniques for the removal of dacryoliths have been described, dacryocystorhinostomy with removal of the dacryoliths remain the most effective treatment in cases of symptomatic dacryolithiasis. The expression and production of certain proteins and peptides, namely those of the trifoil factor family play a significant role in the pathogenesis of dacryoliths. CONCLUSIONS: The management of dacryolithiasis is driven by the goal of resolution of secondary obstruction and/or inflammation. Although a large number of dacryoliths are incidentally found during dacryocystorhinostomy, certain clinical features such as unilateral sac distension, particularly those with a palpable firm medial canthal mass, might lead one to have a high index of suspicion. It remains unclear if the incidental finding of a dacryolith during a dacryocystorhinostomy has a favorable prognostic value.
PURPOSE: To review and summarize the clinical features, presentations, diagnostic modalities and management of dacryolithiasis. METHODS: A comprehensive PubMed search of all English articles on dacryolithiasis was reviewed. Although this review primarily relied on articles written in English, non-English-language articles that had abstracts translated into English were also reviewed. Data reviewed included epidemiology, pathogenesis, appearance and composition, clinical features, presentations, diagnostic modalities, management of dacryolithiasis and the implications of incidental dacryoliths found during lacrimal surgery. RESULTS: Although an unknown proportion of dacryolithiasis cases may remain asymptomatic; epiphora, acute and/or recurrent dacryocystitis, punctal discharge, and localized swelling are the most common presenting features of dacryolithiasis. It may also present as partial nasolacrimal duct obstruction. Dacryoliths exhibit a variety in external appearances. While some minimally invasive techniques for the removal of dacryoliths have been described, dacryocystorhinostomy with removal of the dacryoliths remain the most effective treatment in cases of symptomatic dacryolithiasis. The expression and production of certain proteins and peptides, namely those of the trifoil factor family play a significant role in the pathogenesis of dacryoliths. CONCLUSIONS: The management of dacryolithiasis is driven by the goal of resolution of secondary obstruction and/or inflammation. Although a large number of dacryoliths are incidentally found during dacryocystorhinostomy, certain clinical features such as unilateral sac distension, particularly those with a palpable firm medial canthal mass, might lead one to have a high index of suspicion. It remains unclear if the incidental finding of a dacryolith during a dacryocystorhinostomy has a favorable prognostic value.
Authors: Akshay Gopinathan Nair; Nayana A Potdar; Swaranjali S Gore; Amol Y Ganvir; Monisha K Apte; Trupti R Marathe; Chaya A Kumar; Chhaya A Shinde Journal: Indian J Ophthalmol Date: 2018-04 Impact factor: 1.848