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KMID : 0360220150560091454
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Journal of the Korean Ophthalmological Society
2015 Volume.56 No. 9 p.1454 ~ p.1458
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A Case of Successful Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction with Wegener Granulomatosis
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최시환:Choi Si-Hwan
이민우:Lee Min-Woo/이종주:Lee Jong-Joo/이성복:Lee Sung-Bok
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Abstract
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Purpose: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy.
Case summary: A 36-year-old female diagnosed with Wegener’s granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test.
Conclusions: Nasolacrimal duct obstruction occurring in a patient with Wegener’s granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.
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KEYWORD
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Endoscopic dacryocystorhinostomy, External dacryocystorhinostomy, Nasolacrimal duct obstruction, Silastic sheet, Wegener’s granulomatosis
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