The Research Of Histopathologic And Related Factors In Chronic Dacryocystitis

ObjectiveTo observe the histopathologic changes in mucosa of lacrimal sac of chronic dacryocystitis. To analyze the influence of related factors, including gender, age, duration of inflammation, characteristic of pus, history of acute episode, and the interval between surgery time and the last acute episode of dacryocystitis upon the character and degree of inflammation and fibrosis of lacrimal sac mucosa. To investigate the pathologic mechanism of primary acquired nasolacrimal duct obstruction with chronic dacryocystitis, and the best time of external dacryocystorhinostomy.Methods65 cases (65 eyes) of chronic dacryocystitis caused by primary acquired nasolacrimal duct obstruction were included in this study, all the cases were diagnosed from July, 2009 to July,2010 in General Hospital of Chinese Armed Police Force, and all accepted the improved external dacryocystorhinostomy. Mucous tissue above the conjunction of lacrimal sac and nasolacrimal duct in medial wall of lacrimal sac was excised, and histopathologic analysis was done through Masson three color, HE dyed, and PAS stain. Histopathologic characters of 65 cases were summarized, clinical data was collected, including gender, age, duration of inflammation, characteristic of pus, history of acute episode, and the interval between surgery time and the last acute episode of dacryocystitis. Difference of influence of related factors upon histopathologic characteristic was analyzed by non-parameter test.ResultsIn this study, chronic inflammation was present in all lacrimal sac specimens(65 cases, 65 eyes), it showed predominant lymphocytes and plasma cells infiltration. 34 were mild inflammation, 20 were moderate, and 11 were severe. Lymphoid cells clustering was seen in 2 cases. Subepithelial fibrosis was present in 42 cases, 29 were mild, 6 were moderate, and 7 were severe. Mucous epithelium of of lacrimal sac showed local ulcer in 18 cases, squamous metaplasia in 3, and hyperplasia in 4. Goblet cells fusion present in 31 cases, typical polymorphonuclear leukocytes were seen in 3 cases, and esoinophils were seen in 2 cases. Influence of different factors upon degree of inflammation and fibrosis of lacrimal sac mucosa was as follows: gender and age, no statistical significance (p>0.05) for both. Duration of inflammation, no statistical significance (p>0.05) for inflammation, and significant difference (p<0.01) for fibrosis, the longer the duration of inflammation, the severer the degree of fibrosis.Characteristic of pus, no statistical significance (p>0.05) for inflammation, and significant difference (p<0.05) for fibrosis, the thicker the characteristic of pus, the severer the degree of fibrosis .The history of acute episode of dacryocystitis, significant difference (p<0.01) for both inflammation and fibrosis. The interval between surgery time and the time of last acute episode of dacryocystitis is 1 and 1～2 weeks, significant difference (p<0.05) for inflammation, The interval between surgery time and the time of last acute episode of dacryocystitis is 1～2 and more than 2 weeks, no statistical significance (p>0.05) for inflammation.ConclusionsThe study indicates histopathologic character of chronic dacryocystitis mainly presents as mucosa inflammation and fibrosis. The degree is related to duration of inflammation, characteristic of pus, history of acute episode, the interval between surgery time and the last acute episode of dacryocystitis. The best time of external dacryocystorhinostomy after acute episode in chronic dacryocystitis is within 1 to 2 weeks after redness and swelling subsided in local skin.