Clinicopathological Features of Dacryolithiasis in Japanese Patients: Frequent Association with Infection in Aged Patients

Purpose. The purpose of this study is to elucidate the clinicopathological features of dacryolithiasis and prevalence of associated infection in Japanese patients. Materials and Methods. Out of 13,471 outclinic patients from 2006 to 2011, 268 patients were scheduled to be performed dacryocystorhinostomy (DCR) due to dacryocystitis with nasolacrimal duct obstruction. Actually 266 patients underwent dacryocystorhinostomy (DCR) and two patients were cured by only ophthalmic examination. Dacryoliths were found in 17 cases (6.3%). Among 17 cases of dacryolithiasis, three patients were male, and 14 were female. The age of the patients ranged from 32 to 82 (mean 67) years, and 13 cases (76%) were more than 65 years of age. Pathological examination disclosed the infectious agents in 9 cases (53%), and all patients with infection were more than 65 years of age. Special stains revealed colonies of fungus, suspicious of Aspergillus, in 6 cases and gram-positive rods, and suspicious of Actinomyces, in 3 cases. Conclusions. The current study showed the frequent association of infection with dacryolithiasis in aged Japanese patients. This should be taken into the consideration for the treatment of dacryolithiasis. 1. Introduction Dacryolithiasis is a frequent disease of the lacrimal system, and middle-aged women are commonly affected [1–8]. The pathogenesis of dacryolithiasis is not well understood. The association of infection with dacryolithiasis was reported in the literature [1–8]; however, the prevalence of infection associated with dacryolithiasis in Japanese patients is not known to date. The aim of the current study is to elucidate the clinicopathological features of dacryolithiasis and the prevalence of associated infection in Japanese patients who underwent dacryocystorhinostomy (DCR). 2. Materials and Methods From the archival files of 13,471 patients of the Fukiage Eye Clinic from 2006 to 2011, 268 clinical records of dacryocystitis with nasolacrimal duct obstruction were retrieved, and dacryolithiasis was noticed in 17 cases (Table 1). There was no immune compromise patient in these 17 cases. We did not perform dacryocsytogram and lacrimal endoscopy before DCR; therefore, we have no precise information with nasolacrimal dust obstruction. Cefcapene pivoxil hydrochloride hydrate was continued for four days after the procedure, along with topical antibiotic eye drop and steroid eye drop four times a day for three months. The clinical records and pathological reports of these patients were reviewed. Informed consent was obtained from the patients. Table 1: