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Endoscopic Approach to Management of a Lacrimal Sac Diverticula Mohammad Javed Ali, F.R.C.S. Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India.
FIG. 1. Endoscopic approach to lacrimal sac diverticula: Panel A- Lacrimal sac marsupialization. Panel B- Sac diverticula junction. Panel C- Mucosa to mucosa approximation at the end of the surgery. A, anterior lacrimal sac; D, diverticula; J, junction of anterior flap and diverticula; L, lumen of lacrimal sac; N, agger nasi; P, posterior lacrimal sac flap. Black star, mucosa to mucosa approximation.
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acrimal sac diverticulae are uncommon and characterized by a cystic structure communicating with the sac and can be congenital or acquired. A 35-year-old female presented with leftsided epiphora of 1 year duration and a palpable cystic lesion below the medial canthus. Irrigation of the lacrimal passages was suggestive of a left primary acquired nasolacrimal duct obstruction. An impression of lacrimal sac mucocele was made and patient underwent a left powered endoscopic dacryocystorhinostomy. Following osteotomy, a large cystic area was noted to be arising from the antero-inferior portion of the lacrimal sac
extending beyond the lacrimal fossa. Following marsupialization of the cyst and removal of its medial wall, the lacrimal sac was marsupialized (Fig. 1A). Although the contiguous junction (J) between the anterior lacrimal flap and the diverticula was discernable, the mucosa of the diverticula (D) was smooth without any signs of diverticulitis (Fig. 1B). The surgery was completed with a complete mucosa to mucosa approximation (Fig. 1C, black star) to facilitate healing by primary intention and to prevent recurrences (Fig. 1C). At 6 months follow up, there was no evidence of recurrence and the patient was asymptomatic.
Accepted for publication May 2, 2015. The author has no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Mohammad Javed Ali, F.R.C.S., Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000515
Ophthal Plast Reconstr Surg, Vol. 32, No. 2, 2016
e49
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
Endoscopic Approach to Management of a Lacrimal Sac Diverticula Mohammad Javed Ali, F.R.C.S. Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India.
FIG. 1. Endoscopic approach to lacrimal sac diverticula: Panel A- Lacrimal sac marsupialization. Panel B- Sac diverticula junction. Panel C- Mucosa to mucosa approximation at the end of the surgery. A, anterior lacrimal sac; D, diverticula; J, junction of anterior flap and diverticula; L, lumen of lacrimal sac; N, agger nasi; P, posterior lacrimal sac flap. Black star, mucosa to mucosa approximation.
L
acrimal sac diverticulae are uncommon and characterized by a cystic structure communicating with the sac and can be congenital or acquired. A 35-year-old female presented with leftsided epiphora of 1 year duration and a palpable cystic lesion below the medial canthus. Irrigation of the lacrimal passages was suggestive of a left primary acquired nasolacrimal duct obstruction. An impression of lacrimal sac mucocele was made and patient underwent a left powered endoscopic dacryocystorhinostomy. Following osteotomy, a large cystic area was noted to be arising from the antero-inferior portion of the lacrimal sac
extending beyond the lacrimal fossa. Following marsupialization of the cyst and removal of its medial wall, the lacrimal sac was marsupialized (Fig. 1A). Although the contiguous junction (J) between the anterior lacrimal flap and the diverticula was discernable, the mucosa of the diverticula (D) was smooth without any signs of diverticulitis (Fig. 1B). The surgery was completed with a complete mucosa to mucosa approximation (Fig. 1C, black star) to facilitate healing by primary intention and to prevent recurrences (Fig. 1C). At 6 months follow up, there was no evidence of recurrence and the patient was asymptomatic.
Accepted for publication May 2, 2015. The author has no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Mohammad Javed Ali, F.R.C.S., Dacryology Service, L.V. Prasad Eye Institute, Hyderabad, India. E-mail: [email protected] DOI: 10.1097/IOP.0000000000000515
Ophthal Plast Reconstr Surg, Vol. 32, No. 2, 2016
e49
Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Unauthorized reproduction of this article is prohibited.
