Purpose: To correlate the clinical data to the histopathological characteristics of lacrimal sac and bone specimens in adult patients undergoing indicated external transcutaneous dacryocystorhinostomy surgery (DCR) for primary acquired nasolacrimal duct obstruction (PANDO) in order to determine the important clinical parameters that may necessitate selective lacrimal biopsy in certain situations.
Methods: This is non-comparative, non-controlled descriptive case series study with histopathological correlation. Lacrimal sac and bone specimens for each case were collected during DCR from consecutive patients with PANDO presenting to the outpatient clinic of “Ain Shams University" hospitals, then sent for histopathological examination.
Results: Fifty-one lacrimal specimens were obtained from a total of 49 consecutive patients who underwent external DCR for clinical PANDO at the time interval from March 2018 to March 2020 at “Department of Ophthalmology, Ain Shams University" operating theatre. The mean patients' age was 44.82± 13.63 years (range 21- 75). Among the 49 patients recruited, 6 (12.2%) were males and 43 (87.8%) were females. Non -specific lacrimal sac pathology was present in all 51 samples (3.9% acute inflammation and 96.1% chronic non-specific inflammation). Of the chronic non-specific inflammation specimens, mild degree of inflammation was seen in 40.8%, 44.9% showed moderate chronic inflammation, whereas only 14.3% showed severe inflammatory changes. Observing the histopathological findings of lacrimal sac and bone specimens in our series showed that the inflammation and capillary proliferation were more evident in lacrimal sac specimens especially in moderate and severe cases (p-value <0.01 and 0.03 respectively). The only two clinical parameters that were strongly correlated with the severity of inflammation are the intraoperative appearance of the sac and the presence of a lacrimal fistula with P-value (<0.01).
Conclusions: Lacrimal sac biopsy specimens should not be routinely sent for histopathological assessment after DCR surgery, except for atypical clinical presentation or wary intraoperative appearance. In such situations, lacrimal sac rather than bone specimens should be obtained, being more indicative and revealing of the underlying lacrimal pathology. The most important clinical parameter that strongly correlates with histopathological features is the intraoperative sac appearance. Chronic non-specific inflammation is the most common histopathological feature found in lacrimal biopsy specimens obtained during DCR surgery