Clinical presentation of patients with dacryolithiasis.

Abstract

To compare the demographic characteristics and presentation of patients having dacryolithiasis with those who are free of stones at the time of dacryocystorhinostomy. Retrospective, comparative case series. Patients undergoing treatment in the Lacrimal Service at Moorfields Eye Hospital between 1989 and 1999. Group 1 patients, with lacrimal sac stones found at lacrimal surgery, were compared with three other groups undergoing open lacrimal surgery: a stone-free group with epiphora only (group 2), a stone-free group with dacryocystitis (group 3), and a consecutive cohort of unselected patients operated on over a 5-week period (group 4). Patient demographic characteristics, duration of epiphora, or a history of preceding dacryocystitis were related to the presence or absence of dacryoliths. Thirty-six patients (22 female; 61%) between the ages of 19 and 85 years (mean, 53.8 years; median, 52.5 years) had either single (22 cases; 61%) or multiple dacryoliths. Half of these patients had previous attacks of dacryocystitis. Group 1 patients (with stones) sought treatment earlier than all of the other groups: 13.5 months compared with 36.5 months (group 2; P = 0.01), 48.7 months (group 3; P = 0.05), and 52.2 months (group 4; P = 0.02). Group 1 patients are much more likely to have prior attacks of dacryocystitis than patients without stones (18/36 in group 1, 10/45 in stone-free patients; P = 0.009). In all groups, there was a slight preponderance of females, but there was no difference in gender or age at presentation. Patients with dacryolithiasis are likely to have a shorter history of epiphora and previous attacks of dacryocystitis at presentation. There is no gender or age difference between the lacrimal stone and stone-free patients undergoing open lacrimal surgery.