gms | German Medical Science

Background: Epiphora is the cardinal symptom of diseases of the tear passages. It appears with overproduction of tear fluid, anatomical variants, functional disorders and particularly with obstruction. Chronic dacryocystitis, tumors, foreign bodies and primary nasal disorders show common unspecific symptoms like medial epiphora, swelling and reddening of the medial canthus and recurrent inflammation. Therefore it is a challenging differential diagnosis. In 10 – 15 % of patients imaging shows masses like intra or extra luminal tumors, mucoceles, chronic sinusitis or dacryoliths. Based on two case reports we want to describe our concept of proceeding diseases of the tear passages.

Case Reports: 1) A 43-year old man presenting reduced nasal breathing and right sided epiphora since one year. The canthus and endonasal mucosa were bland, but irrigatin of the right tear duct was not possible. A CT-scan showed a soft tissue mass in the right tear duct. Intraoperatively it turned out to be a benign papilloma and was completely resected. The tear passage was reconstructed with silicone tubes. 2) A 74 year old woman presenting with therapy-resistant dacryocystitis and a canthal mass since three weeks. A large exophytic tumor was endoscopically detected in the nasal cavity. CT and later MRI scans show a destructive soft tissue mass of the right tear duct, nasal cavity, paranasal sinus and orbita. A biopsy showed a Wegener’s granulomatosis. She was treated with usual chemotherapy.

Conclusion: We recommend a CT scan of the paranasal sinus and orbita before every operation. It should detect pathological structures of the tear passages or surrounding tissues. Together with anamnesis and clinical findings it leads to comprehensively obtained picture and consecutively aiming to a one-stage operation with complete resection and reconstruction. The threshold of taking biopsies should be low in order to detect occult mucosa lesions.