Case Reports of Lacrimal Sac Tumors Discovered in Patients with Persistent Epiphora Following Dacryocystorhinostomy

Dear Editor, Recently, we experienced two cases of lacrimal sac tumors discovered in patients who presented with persistent epiphora after receiving dacryocystorhynostomy (DCR). A 75-year-old female visited the clinic complaining persistent epiphora in the right eye for 5 years. The patient was diagnosed with nasolacrimal duct obstruction in the right eye and received a DCR twice 2 years ago at a local hospital, but epiphora persisted post operation. Lacrimal irrigation test revealed a reflux through contralateral puncta in the right eye. There was a protrusion superior to medial can-thus and a mass was palpable at the medial side of the right orbit. Computed tomography (CT) scan confirmed a 3-cm-sized mass involving the right lacrimal sac and surrounding soft tissue of inferomedial orbit (Fig. 1A and 1B). An excisional biopsy was performed and diagnosed as invasive squamous cell carcinoma from lacrimal sac. Wide resec-tion of lacrimal sac and nasolacrimal duct via anterior or-bitotomy and medial maxillectomy via lateral rhinotomy was performed (Fig. 1C). The patient received adjuvant ra-diotherapy and is under observation. The second case presents a 51-year-old female whose history included a DCR received at a local hospital for epiphora in the left eye. She was complaining of persistent epiphora and swelling of upper and lower eyelids. The slit Correspondence Fig. 1. Computed tomography (CT) scan and operation images of epiphora patients diagnosed with tumor in lacrimal duct (A,B). Pre-operative orbital CT images of the 75-year-old female patient show a 3-cm mass at the right lacrimal sac. (C) An excisional biopsy was performed and a mass invading the lacrimal sac and the inferomedial orbit was found (D) and (E). Preoperative orbital CT images of the 51-year-old female patient show a mass invading the left lacrimal sac and the inferomedial orbit. (F) An excisional biopsy was performed and a mass invading the left lacrimal sac was observed.