Lacrimal Sac Dacryoliths (86 Samples): Chemical and Mineralogic Analyses

INTRODUCTION It is not unusual to find a stone in the lacrimal sac during dacryocystorhinostomy (DCR). Although patients with dacryolithiasis often have a history of long-term intermittent epiphora, lacrimal sac distention, and/or partial obstruction of the nasolacrimal duct (NLD), dacryoliths are often only detected during DCR. The incidence of dacryoliths in the lacrimal sac of patients that undergo DCR ranges from 6.0-18.0%; however, the incidence of dacryoliths has not been evaluated in the general population. Unfortunately, most published studies on dacryoliths have included quite a small number of samples.

Canalicular concretions have long been associated with canaliculitis caused by actinomycotic infection. However, despite recent, significant progress, an understanding of the pathophysiology of lacrimal sac dacryoliths is still missing. Several predisposing factors have been suggested to contribute to the mechanism that gives rise to dacryolith formation. These factors include age (under 50 years old), sex (increased frequency in females), cigarette smoking, and previous occurrence of chronic dacryocystitis and primary acquired nasolacrimal duct obstruction (PANDO). Recent analyses have shown that dacryolith development may be related to lacrimal sac epithelial and NLD production of a broad spectrum of mucins and expression of two peptide members of the trefoil factor family (TFF), TFF1 and TFF3. Because dacryoliths occur at low frequency, few studies have focused on their composition.

In this study, the authors aimed to present findings from morphological, chemical, and mineralogic analysis of 86 dacryoliths.

MATERIALS AND METHODS A total of 967 primary EDCRs were performed at the Department of Otorhinolaryngology of the University Hospital of Ostrava and at the Department of Otorhinolaryngology of the Frydek-Mistek City Hospital between 1994 and April 2012. Only EDCRs performed for postsaccal stenosis/obstruction (832 procedures) were included in the study. Exclusion criteria were presaccal obstruction treatment, revision EDCRs, and incomplete follow-ups.

The study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice, and applicable regulatory requirements. Written consent was obtained from all patients before the initiation of surgery and dacryolith analysis.