Braz. j. . vol.80 número6

BrazJOtorhinolaryngol.2014;80(6):540---541

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

www.bjorl.org

CASE

REPORT

Lacrimal

sac

mucocele

夽

Mucocele

de

saco

lacrimal

Silvia

Bona

do

Nascimento

_,

_Ana

_Baleska

_Rodrigues

,

Talline

Priscila

Magalhães

Jurity

_,

_Jéssica

_Coelho

_de

_Sá

_,

Anísio

Neto

de

Oliveira

Castelo

Branco

a_{CentroUniversitárioUNINOVAFAPI,Teresina,PI,Brazil} b_{HospitalFlávioSantos,Teresina,PI,Brazil}

Received15August2012;accepted15December2012 Availableonline23May2014

Introduction

Lacrimalsacmucocele(LSM)ischaracterizedbyobstruction ofthenasolacrimalduct(NLD)withconsequentdilatation and distension of the lacrimal sac (LS) by mucopurulent material.1 _{This report aimed to describe this condition,} whichisrareinadults,discussingitsformationmechanisms, differentialdiagnosis,andtreatment.

Case

report

A female patient, 54 years old, complained of excessive tearing in the right eye for 12 years. After four years, she presented with progressive obstruction of the nasal passages. Approximately one year before presenting to thisservice, abulgingswelling,painfuluponcompression, appearedneartheinnercorneroftherighteye.On physi-calexamination,shedemonstratedepiphoraintherighteye andacysticlesionassociatedwithrednessoftheoverlying skin,closetothemedialcorneroftherighteye,measuring 1.2cmindiameter(Fig.1A).

夽 _{Pleasecitethisarticleas:doNascimentoSB,RodriguesAB,Jurity}

TP,deSáJC, CasteloBrancoAN.Lacrimal sacmucocele.Braz J Otorhinolaryngol.2014;80:540---1.

∗_{Correspondingauthor.}

E-mail:baleska91@hotmail.com(A.B.Rodrigues).

The swelling showed no drainage on expression, nor regurgitationof secretionthrough thecanaliculi.Anterior rhinoscopy disclosed total obstruction of the right nasal cavityand,ontheleft,reducedlumenduetoseptal devi-ation.Computedtomography(CT)evidencedalesionwith softtissueconsistencyattheethmoid,rightmaxillarysinus, andnasalcavity,showingerosionofthelaminapapyracea, with compression of the medial rectus muscle and eye-ball displacement, aswell aserosionanddisplacement of the nasal septum to the left, consistent with mucocele (Fig.1B). Thus,surgical treatment was performed, which discloseda pouchfilledwithmucopurulentmaterial origi-natingfromthelacrimalsac.Surgicalmarsupializationwas carriedout.Aftersixmonths,the patientremains asymp-tomatic.

Discussion

LSMrarelyaffectsadults.2_{Itiscausedbytheaccumulation} oftearsecretioninthemedialcanthalregiondueto obstruc-tionofthenasolacrimalduct,generatingadacryocystocele, followedbytheappearanceofaninfectious/inflammatory process that characterizes the mucocele.3,4 _{On physical} examination,thecharacteristicofLSMisanon-compressible massinthemedialcanthalregion,withorwithout associ-atedcellulitisoftheoverlyingskin.1,3

http://dx.doi.org/10.1016/j.bjorl.2014.05.001

Lacrimalsacmucocele 541

Figure1 (A)Macroscopicaspectofthelesioninthemedialregiontotheeyeball.(B)Computedtomographyoftheparanasal sinuses,coronalsection.

In adults, LSM is often a result of acquired chronic obstructionoftheNLD1,2_{andsecondaryblockageof} canali-culi.TheNLDobstructionmaybeduetochronicinfections, mainly low pathogenicity bacteria and fungi; dacryoliths anatomical alterations, such as anomalousethmoid cells, facialfractures,orcomplicationsofnasalsurgeries;anduse ofcertaindrugs(fluorouracilanddocetaxel).1,5_Neoplasms of the nasolacrimal sac or duct or of adjacent structures areextremelyrarecausesofNLDobstruction.AcquiredNLD obstructionismorecommoninfemales.6

The erosionof facialbones resultingfrom along-term compressionismediatedbytheproductionofinflammatory mediatorsorcompressiveeffect.2

Itis essentialtoobtainaCToftheparanasalsinusesif other LSpathologies or significantnasal comorbiditiesare suspected,orforpreoperativereview.2_{Magneticresonance} imagingisvaluableinthediagnosisofLStumors,whichare usuallymalignantandcanmimicmucocelesonCTscans.2

The differential diagnosis ofLSM shouldinclude dacry-ocystitis,lacrimalsacdiverticulum,encephalocele,ethmoid andmaxillarymucoceles,dermoidorepidermoidcysts,and neoplasiaoftheLSorcontiguousstructures.1---6

Neoplasiaissuspectedwhenthelesionoccursabovethe medialcanthalligament,ifthereisseverepain,bloody dis-chargethroughthelacrimalcanaliculi,orpalpablemassin thetopographyofLSandbonedestruction.1---6

The treatment is commonly performed together by the ophthalmologist and otolaryngologist. In adults, the treatment of choice is dacryocystorhinostomy due to the ineffectivenessofconservativetreatmentandrarityof spon-taneous regression.5 _{Satisfactory results have also been} reportedwithstentplacementinthenasolacrimalduct.3

Final

comments

LSMinadultsismostoftenacomplicationofchronic dacry-ocystitis caused by chronic obstruction of the NLD and secondaryblockageofcanaliculi.Theevaluationofchoice iscomputed tomography ofthe paranasalsinuses andthe indicatedtreatmentisdacryocystorhinostomy.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

References

1.PerryLJP,JakobiecFA,ZakkaFR,RubinPAD.Giant dacryocysto-mucopyoceleinanadult:areviewoflacrimalsacenlargements with clinical and histopathologic differential diagnoses. Surv Ophthalmol.2012;57:474---85.

2.KatarzynaEK,HarpreetA. Chronicdacryocystitiswith sponta-neousresolutionofsacmucocele:factorfiction.OphthalPlast ReconstrSurg.2011;27:e90---2.

3.XiaoMI,TangLS,ZhuH,LiHJ,LiHL,WuXR.Adultnasolacrimal sacmucocele.Ophthalmologica.2008;222:21---6.

4.Yip CC, McCulley TJ, Kersten RC, Bowen AT, Alam S, Kul-win DR.Adultnasolacrimal ductmucocele. Arch Ophthalmol. 2003;121:1065---6.

5.WooKI,KimYD.Fourcasesofdacryocystocele. KoreanJ Oph-thalmol.1997;11:65---9.