External dacryocystorhinostomy resolves epiphora in patients with systemic sarcoidosis

This retrospective review describes the clinical outcomes of 75 external dacryocystorhinostomy (DCR) procedures in patients with systemic sarcoidosis.

Study design

The authors retrospectively reviewed the charts of 47 patients with systemic sarcoidosis who underwent external DCR, and recorded each patient’s gender, affected organs and immunosuppressive regimen. Systemic immunosuppression remained unchanged. A successful clinical outcome was defined as resolution of epiphora.

Outcomes

A total of 60 primary DCRs and 15 repeat DCRs were performed, and 72% of the patients were not receiving systemic immunosuppression at the time of surgery. Epiphora was cured in 85% of patients after primary surgery and in 73% of patients after repeat DCR. Patients were followed for an average of 34 months after primary DCR. Four patients ultimately required a glass Jones tube, and 1 of these patients demonstrated persistent epiphora.

Limitations

These authors found satisfactory results without increasing immunosuppression. Other studies have suggested that long-term failure rates may reflect chronic smoldering disease. The current study had a longer follow-up period than most studies, but this period may not have been long enough to detect all recurrences since these can happen after many years.

Clinical significance

External DCR with a wide mucosal anastomosis successfully treats most patients with lacrimal obstructions in the setting of sarcoidosis. This is true even without adding or increasing systemic immunosuppression.