Dacryolithiasis in the lacrimal sac as an intraoperative finding in endoscopic dacryocystorhinostomy: A case report and long-term follow-up

Abstract

Dacryoliths are concretions composed of organic material and mineral salts, formed from epithelial cells, proteins, and debris that mineralize with calcium. Their occurrence within the lacrimal drainage system is rare, with an incidence reported between 3% and 9.9%. In terms of pathophysiology, chronic obstruction of the nasolacrimal duct leads to the accumu­lation of waste, favoring the formation of dacryoliths. The triggering event is thought to be epithelial rupture of the nasolacrimal pathway, secondary to physical or chemical trauma in a susceptible individual. We present the case of a 31-year-old female patient with inter­mittent epiphora in the left eye, diagnosed with left dacryocystocele. After an unsuccessful attempt at conservative treatment with probing and intubation, an endoscopic dacryocys­torhinostomy was performed, during which an incidental 1 cm dacryolith completely oc­cupying the lumen of the lacrimal sac was extracted. Histopathology revealed a dacryolith composed of proteinaceous material and signs of chronic inflammation. After the interven­tion, the patient experienced complete resolution of symptoms, with no recurrence after six years of follow-up. Although targeted evaluation for dacryolithiasis is possible, dacryoliths are often diagnosed incidentally during dacryocystorhinostomy procedures. This surgical intervention is considered the gold standard for managing nasolacrimal duct obstruction in patients with dacryolithiasis. In Chile, no studies have documented the epidemiology of this diagnostic entity, nor have there been reports of incidental dacryolithiasis cases during nasolacrimal surgeries.