The Dacryocystorhinostomy Ostium Granulomas: Classification, Indications for Treatment, Management Modalities and Outcomes.
AIM
Ostium granulomas following dacryocystorhinostomy (DCR) have not been studied in detail previously. This study aims to classify the DCR-related granulomas based on their ostial locations and to assess the outcomes of their management.


METHODS
A retrospective consecutive case series of 47 ostial granulomas evaluated over a period of 2 years were included in this study. All patients underwent detailed endoscopic examination to assess the granuloma locations and their response to initial topical steroids treatment. Persistent granulomas either underwent further management with excision or intralesional steroids based on their location. Patients were followed up for a minimum of 6 months. The primary outcome measure was resolution of granuloma.


RESULTS
The mean age at presentation was 45 years with a female preponderance (68%). 70% (33/47) of granulomas were following external DCR and 30% (14/47) occurred in the setting of endonasal DCR. The most common location was an edge granuloma in 46.8% (22/47) followed by a combined granuloma in 21.2% (10/47). 91.4% (43/47) underwent initial treatment with topical nasal steroids. The remaining 4 (8.5%) underwent primary excision. Among those treated with topical steroids (n = 43), 9.3% (4/43) underwent further treatment with intralesional triamcinolone. Overall, 4.2% (2/47) recurred in 6 weeks following resolution and were treated with excision.


CONCLUSION
We recommend routine endoscopic evaluation of all the DCR ostia. Detection of granulomas in early stages and appropriate management as per guidelines proposed may aid in better outcomes.
['Ali|Mohammad Javed|MJ|', 'Wormald|Peter John|PJ|', 'Psaltis|Alkis James|AJ|']
D000328:Adult D000368:Aged D003131:Combined Modality Therapy D003608:Dacryocystorhinostomy D005260:Female D005938:Glucocorticoids D006099:Granuloma D006801:Humans D007766:Lacrimal Apparatus Diseases D008297:Male D008875:Middle Aged D009301:Nasolacrimal Duct D013508:Ophthalmologic Surgical Procedures D011183:Postoperative Complications D012189:Retrospective Studies D014222:Triamcinolone Acetonide D055815:Young Adult
ostium granuloma DCR lacrimal nasal endoscopy