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Nasal and Lacrimal Sac Histopathology in Patients With Systemic Sarcoidosis Undergoing External Lacrimal Drainage Surgery

Stewart, Christopher M., MBBS, FRANZCO*; Luthert, Philip J., M.D., Ph.D.; Rose, Geoffrey E., D.Sc., F.R.C.Ophth.*

Ophthalmic Plastic & Reconstructive Surgery: May/June 2019 - Volume 35 - Issue 3 - p 247–250
doi: 10.1097/IOP.0000000000001217
Original Investigations

Purpose: To review the histological findings in the lacrimal sac and nasal mucosa from patients with sarcoidosis undergoing external lacrimal drainage surgery.

Methods: All patients undergoing external dacryocystorhinostomy at Moorfields Eye Hospital with a known history of sarcoidosis had biopsies taken from the lacrimal sac and/or nasal mucosa during surgery. These patients were identified from databases at Moorfields Eye Hospital and the Institute of Ophthalmology, and their clinical notes were reviewed retrospectively for intraoperative findings with a view to identifying common trends. The histological findings of each biopsy were reviewed and classified as showing granulomas, nongranulomatous inflammation, or nonspecific fibrosis.

Results: Forty patients (29 females; 72%) were known to have systemic sarcoidosis prior to surgery, and they underwent 60 external dacryocystorhinostomies. Paired histological samples were available from 49/60 (82%) procedures, nasal biopsies alone in 3 dacryocystorhinostomies (5%), and solely lacrimal sac biopsies in 8 (13%). The main site of systemic sarcoidosis was pulmonary involvement (19 patients; 48%). Recorded operative findings included 9 large lacrimal sac mucoceles (29%), a “thick” (26%) or “inflamed” (9.7%) lacrimal sac mucosa, and “thick” (36%) or “friable” (32%) nasal mucosa. Noncaseating granulomas were identified in 34/57 (60%) sacs, and 45/52 (87%) nasal tissues—this being in 31/49 (63%) of paired tissues. Chronic inflammation, without granulomas, was present in 20/57 (35%) lacrimal sacs but only in 5/52 (9.6%) of nasal biopsies.

Conclusions: In patients with sarcoidosis undergoing external dacryocystorhinostomy, the characteristic histological feature—noncaseating granulomas—is present in most patients’ lacrimal sac mucosa and in almost all of their nasal mucosae. The lacrimal sac and nasal mucosa often appears abnormal—thickened or friable—during surgery.

Patients with sarcoidosis undergoing external dacryocystorhinostomy are likely to have chronic noncaseating granulomatous inflammation present in almost all their nasal mucosae and many of their lacrimal sac mucosae.

*Adnexal Service, Moorfields Eye Hospital, London, United Kingdom

Department of Histopathology, Institute of Ophthalmology, London, United Kingdom

Accepted for publication July 14, 2018.

G.E.R. receives some funding from the Department of Health’s National Institute of Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College, London Institute of Ophthalmology.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Geoffrey E. Rose, D.Sc., F.R.C.Ophth., Adnexal Service, Moorfields Eye Hospital NHS Foundation Trust, City Road, London EVC1V 2PD, United Kingdom. E-mail:

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.