Sarcoidosis of the Lacrimal Duct - A Case Report
Bauer A. M., Becker M. D., Völcker H. E.
Interdisciplinary Uveitis Center, Dept. of Ophthalmology, University of Heidelberg
Purpose: Sarcoidosis is a multisystemic, granulomatous disease of unknown origin. In about one third of all cases ophthalmic manifestation occurs most often involving uvea, retina, conjunctiva and the lacrimal system.
Method: We report about a 48 year-old female patient who was sent to us in August 2001 presenting with unilateral retinal periphlebitis, macula edema, and epiphora. Systemic workup was unsuccessful. Due to diabetes mellitus no systemic steroid therapy was applied. Therefore and because of the unilateral findings we administered peribulbar corticosteroid injections leading to a fast recovery of periphlebits and macula edema. Unfortunately, epiphora persisted.
It was nearly impossible to flush the lacrimal drain. Digital subtraction angiography of the lacrimal system showed an irregular lumen and stenosis of the whole lacrimal duct. Biopsy of the lacrimal duct revealed epitheloid-cell granulomas without caseous degeneration equivalent to sarcoidosis.
The use of topical corticosteroids applied as eye drops led to a quick recovery from tearing. A surgical procedure was not necessary.
Conclusions: Sarcoidosis as the cause of epiphora should be considered especially in the field of uncertain intraocular inflammation. If sarcoidosis of the lacrimal duct is verified, the use of fluid topical corticosteroids seems to be justified.
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