Canalicular obstruction: a histopathologic case series.

OBJECTIVE

To investigate the histopathologic causes of canalicular obstruction in a case series of patients treated by canalicular trephination for symptomatic epiphora.

DESIGN

A university and private practice retrospective chart review.

PARTICIPANTS

The study involved 12 consecutive patients who underwent unilateral canalicular trephination with tissue retrieval for the treatment of canalicular obstruction.

METHODS

Canalicular obstruction was confirmed at the time of preoperative and intraoperative probing and irrigation. Treatment consisted of canalicular trephination combined with silicone intubation and a concomitant dacryocystorhinostomy in 6 cases. Tissue was recovered from the trephine lumen and submitted for pathologic analysis. Predisposing factors that could have caused canalicular obstruction and the clinical course following treatment were reported.

RESULTS

The most common histopathologic finding was nonspecific inflammation with associated fibrosis. Cases demonstrating sebaceous gland adenoma, skeletal muscle, adipose tissue, and bone were identified.

CONCLUSIONS

Use of the lacrimal trephine to open canalicular obstructions provided tissue samples that revealed nonspecific inflammation and fibrosis as a common underlying histopathology. The presence of skeletal muscle and adipose tissue suggests a decrease in canalicular diameter or such dense scarring that the normal canalicular architecture could not be followed. Other causes of canalicular obstruction such as lacrimal sac tumors should be considered in the differential diagnosis.