Mascara-induced nasolacrimal duct obstruction

Abstract

A 35-year-old woman underwent left external dacryocystorhinostomy (DCR) following a recent bout of left acute dacryocystitis. She had a right DCR 14 years earlier. Her relatively young age of presentation prompted suspicion of secondary nasolacrimal duct obstruction and, although the left lacrimal sac appeared macroscopically normal peroperatively, a lacrimal sac biopsy was taken. Histopathology revealed florid chronic inflammation, with abundant granular brown pigment and polarisable crystals suggestive of an exogenous material in the lacrimal sac mucosa compatible with mascara. After initial improvement, her epiphora has recurred 1-year postoperatively, but her ocular discharge has resolved. Mascara-induced conjunctival pigmentation is well established. However, there are very few published reports of nasolacrimal duct obstruction due to mascara. Since cosmetic application of mascara and kohl eyeliner is widespread, patients and practitioners should be aware of their potential to migrate into the lacrimal apparatus and cause chronic inflammation with secondary nasolacrimal duct obstruction.

Keywords: ophthalmology; pathology; plastic and reconstructive surgery.

Figure 1

H&E stain of the left lacrimal sac (×100 magnification). The fibrous connective tissue with respiratory type epithelium lining shows a florid chronic inflammatory infiltrate with a lymphoid follicle (arrow) comprising a germinal centre and a mature mantle of lymphocytes. Lymphocytes, histiocytes and plasma cells are present in the stroma with abundant granular brown pigment but with no evidence of neoplasia.

Figure 2

(A) H&E stain of the left lacrimal sac (×400 magnification) showing brown pigment, which is contained in macrophages. (B) Under polarised light, a portion of the granular brown pigments demonstrate polarisable crystals.