Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1940
Peer-review started: November 5, 2020
First decision: December 28, 2020
Revised: January 8, 2021
Accepted: January 22, 2021
Article in press: January 22, 2021
Published online: March 16, 2021
Nasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare.
A 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.
This case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.
Core Tip: Localized amyloidosis is a very rare cause of nasolacrimal duct obstruction and dacryocystitis. It has been reported that amyloidosis in nasolacrimal excretory system may be invasive or present as a pseudo-dacryolith with clear boundary in liquid or colloidal forms. However, massive dacryolithiasis can also be formed and obstruct the nasolacrimal excretory system as a consequence. Computed tomography examination can be a noninvasive tool for preoperative evaluation in case of incapability of dacryocystorhinostomy and nasal endoscopy of fully displaying deeper structures of nasolacrimal excretory system.