Duration 5min, Q&A 3min
Lacrimal Sac Rhinosporidiosis: Clinical Profile and Surgical Management by Modified Dacryocystorhinostomy
To describe the clinical profile of lacrimal sac rhinosporidiosis cases and our modified surgical approach and outcomes .
Eighteen patients were included in the study. All these patients were presented with soft doughy swelling in lacrimal sac region with history of occasional epistaxis or blood stained discharge from puncta and were suspected to have lacrimal sac rhinosporidiosis.
This is a retrospective interventional case series. The patients who were clinically diagnosed as isolated lacrimal sac rhinosporidiosis, , were included in the study. Detailed history including whether there was exposure to stagnant bathing water was noted. Relevant clinical presentations were also noted. Being diagnosed clinically, the patients were referred to the ENT specialist for naso-pharyngeal cavity examination. All patients underwent modified dacryocystorhinostomy (DCR) under general anaesthesia. The significant modifications were excision of sac content and most part of the sac except a small portion around common canalicular opening, extensive cauterization in the surrounding tissue and application of 5% povidone iodine soaked gauze in the lacrimal fossa for 2 minutes. The sac content was confirmed as rhinosporidiosis in all cases by histopathology .
Results and Conclusion
The patient age range was 5 to 54 years and the occurrence of rhinosporidiosis was highest in the age group between 25 to 34 years. Males were more often affected (Male : Female ratio 3.5:1) . 12 patients (66.67%) gave a clear history of either regular or occasional bathing in stagnant water where exposure to the organism was likely to have occurred.
All 18 patients had doughy swelling over lacrimal sac region and 11 of them also exhibited a bloody discharge from the nose. Only 4 patients had epiphora due to a blocked lacrimal passage. Two of these patients also had a cutaneous fistula through which reddish granular lesional tissue had prolapsed. Oral and nasopharyngeal examination was normal in all cases. Patients were followed up for one year and only two patients had a recurrence at the sac site. Both these patients had blocked lacrimal passage and cutaneous fistula.
Patients with lacrimal sac rhinosporidiosis usually present with a soft, doughy swelling in the lacrimal sac area. Bathing in stagnant water is a critical risk factor. The definitive treatment for lacrimal sac rhinosporidiosis is the excision of the involved sac, by dacryocystectomy (DCT). Persistent and troublesome epiphora usually occur after DCT operation. To avoid this discomfort, we have managed all our patients with modified dacryocystorhinostomy (DCR) which has yielded excellent outcomes.
[ Keyword ]
Rhinosporidiosis / Oculosporidiosis / Dacryocystorhinostomy
[ Conflict of Interest ]