External dacryocystorhinostomy in patients with granulomatous polyangiitis

Abstract

Aim: To review the outcome for primary or revisional external dacryocystorhinostomy in patients with granulomatous polyangiitis.

Patients and methods: Retrospective case-note review to include age at presentation, duration of prior GPA, immunosuppression at time of surgery, nature of first lacrimal surgery, and symptomatic control.

Results: Forty-eight patients (25 female; 52%) presented at an average age of 50.5 years and 7 (15%) had prior lacrimal surgery on one (5/7; 71%) or both sides. The duration of systemic GPA varied, with 40% having disease for up to 3 years prior to lacrimal referral, and 41/48 (85%) being on systemic immunosuppression. Forty-eight patients had 71 affected drainage pathways-having symptoms for an average of 22 months (range <1 month to 7 years). Surgery was undertaken on 70/71 systems-62/70 primary DCRs (20 unilateral; 8 simultaneous bilateral; 13 sequential bilateral). Of nine systems with persistent symptoms after prior surgery, eight underwent revisional surgery (six unilateral; one sequential bilateral). With a follow-up of 2.5 years (range 3 months to 14 years), volume symptoms were cured in all 70 cases. Flow symptoms were controlled in 58/62 (94%) systems after primary DCR, and all eight after revisional surgery. Of four sides with persistent epiphora, one was cured with revisional DCR and three with placement of Jones' canalicular bypass tubes.

Conclusion: Mucoid discharge, dacryocystitis and recurrent conjunctivitis were cured in all patients with GPA after either primary and revisional surgery. Continued epiphora was controlled in most patients with additional closed procedures.

Fig. 1

Typical nasal endoscopic appearance of patients with chronic sino-nasal granulomatous polyangiitis, showing a loss of nasal structures with extensive, thick crusting and haemorrhagic and scarred underlying mucosa, and b widespread scarring with a large nasal septal perforation