Abstract
Background
To describe the clinical presentation, surgical intervention and clinical outcomes of patients with a lacrimal sac diverticulum.
Methods
Retrospective chart review of all patients who underwent endonasal endoscopic dacryocystorhinostomy (DCR) in a single medical center from January 2010 to October 2020. The diagnosis of a lacrimal sac diverticulum was based upon intraoperative findings.
Results
In total, 406 patients underwent endonasal endoscopic DCR during the study period. Eight female patients (mean age 35 years) were diagnosed with a lacrimal diverticulum and underwent DCR by an endonasal endoscopic approach. The mean follow-up period was 11.5 months. All eight patients had cystic findings at the lacrimal fossa on imaging studies prior to surgery. Five patients had a history of dacryocystitis. The main presenting symptoms were epiphora and/or medial canthal swelling. The diverticulum was identified on the inferior wall in seven cases. A dacryolith in the lacrimal sac was identified intraoperatively in two patients. All patients showed full resolution of symptoms after surgery. There were no intraoperative or postoperative complications.
Conclusion
Lacrimal sac diverticulum is a rare entity with female predominance. It may be the underlying etiology of epiphora and/or dacryocystitis. The diagnosis is based upon identifying the presence of a diverticulum intraoperatively. Endoscopic DCR is an effective approach for integrating both the lacrimal sac and diverticulum cavities into a single space, leading to resolution of symptoms.
Similar content being viewed by others
References
Kavanagh MC, Cahill KV (2008) Congenital lacrimal system anomalies mimicking recurrent acute dacryocystitis. Ophthalmic Plast Reconstr Surg 24:53–54
Ali MJ (2018) Atlas of lacrimal drainage disorders. Springer, pp 341–346
Ali MJ, Naik MN (2017) Congenital lacrimal sac diverticulum. Saudi J Ophthalmol 31:199–200
Ormrod JN (1958) Diverticulum of the lacrimal sac. Br J Ophthalmol 42:526–528
Kim JH, Chang HR, Woo KI (2012) Multilobular lacrimal sac diverticulum presenting as a lower eyelid mass. Korean J Ophthalmol 26:297–300
Malik SRK, Gupta AK, Chaterjee S et al (1969) Dacryocystography of normal and pathological lacrimal passages. Br J Ophthalmol 53:174–179
Sinnreich Z (1998) Lacrimal diverticula. Orbit 17:195–200
Enright NJ, Brown SJ, Rouse HC et al (2019) Nasolacrimal sac diverticulum: a case series and literature review. Ophthalmic Plast Reconstr Surg 35:45–49
Polito E, Leccisotti A, Menicacci F et al (1995) Imaging techniques in the diagnosis of lacrimal sac diverticulum. Ophthalmologica 209:228–232
Bharathi MJ, Ramakrishnan R, Maneksha V et al (2008) Comparative bacteriology of acute and chronic dacryocystitis. Eye (Lond) 22:953–960
Buratto L, Alio JL, Pandey SK et al (eds) (2002) Textbook of ophthalmology. Lippincott Williams & Wilkins, p 705
Gupta A, Prabhakaran VC, Dodd T et al (2012) Characterization of lacrimal sac histology: an immunohistochemical study. Clin Exp Ophthalmol 40:869–873
Baybora H, Uysal HH, Baykal O (2019) Investigating estrogen and progesterone receptors in the lacrimal sacs of individuals with and without chronic dacryocystitis. Beyoglu Eye J 4:38–41
Ali MJ, Schicht M, Paulsen F (2017) Qualitative hormonal profiling of the lacrimal drainage system: potential insights into the etiopathogenesis of primary acquired nasolacrimal duct obstruction. Ophthalmic Plast Reconstr Surg 33:381–388
Ali MJ (2016) Endoscopic approach to management of a lacrimal sac diverticula. Ophthalmic Plast Reconstr Surg 32:e49
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cnaan, R.B., Abumanhal, M., Wengier, A. et al. Lacrimal sac diverticulum: clinical presentation and endoscopic management. Eur Arch Otorhinolaryngol 279, 199–203 (2022). https://doi.org/10.1007/s00405-021-06773-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-021-06773-x