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Small Case Series
Sepetmber 2010

Endonasal Dacryocystorhinostomy in Wegener Granulomatosis

Author Affiliations

Author Affiliations: Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada (Drs Morris and Dolman); and Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, University of Adelaide and the South Australian Institute of Ophthalmology, Adelaide (Dr Selva).

Arch Ophthalmol. 2010;128(9):1212-1214. doi:10.1001/archophthalmol.2010.191

Wegener granulomatosis (WG) is a life-threatening autoimmune disease of unknown etiology first described in 1936. The classic clinical triad consists of necrotizing granulomatous inflammation of the respiratory tract, necrotizing glomerulonephritis, and systemic vasculitis. Prior to the introduction of modern immunosuppressants, WG was usually fatal due to renal complications. Involvement of the eye and adnexal structures is common, occurring in 29% of patients. Nasolacrimal duct obstruction (NLDO) following necrosis of the nasal tissue is seen in 7% of patients,1 who may seek relief through lacrimal surgery.

Dacryocystorhinostomy (DCR) has been shown to be a safe, effective intervention2,3 but failures and complications are more common in this patient group.3-5 While conventional teaching recommends an external approach,2 increasing use of the endonasal approach (EN-DCR), with or without an endoscope, raises the question of whether it can be used safely and successfully in WG. We present 4 cases treated endonasally (cases 1 and 2 using endoscopy by D.S., cases 3 and 4 using direct visualization by P.J.D., customary for each surgeon) and offer further advice on management of this patient group