Evaluation of inflammation-related histopathological changes in the lacrimal sac, nasal bone, and nasal mucosa in cases of primary acquired nasolacrimal duct obstruction.

PURPOSE: To evaluate inflammation-related histopathological changes in the lacrimal sac, nasal bone, and nasal mucosa in patients with primary acquired nasolacrimal duct obstruction (PANDO). METHODS: This prospective case series included 31 eyes of 31 patients who underwent external dacryocystorhinostomy due to PANDO. Lacrimal sac, nasal bone, and nasal mucosa specimens were obtained during surgery. The specimens were evaluated for the presence of chronic inflammation-related histopathological changes, specifically chronic inflammatory cell infiltration, fibrosis, and capillary proliferation. The severity of these histopathological changes was also graded. RESULTS: The male-to-female ratio was 10/21, and the mean age of the patients was 52.16 ± 9.12 years (range: 43-67). There were several inflammation-related histopathological changes in the lacrimal sac, including moderate inflammatory cell infiltration (38.71%), mild fibrosis (70.97%), and severe capillary proliferation (48.39%). There were no histopathological changes in the nasal bone specimens. In nasal mucosa specimens, mild inflammatory cell infiltration (60.00%) was observed. There was no significant correlation between the severity of lacrimal sac histopathological findings and inflammatory cell infiltration in the nasal mucosa (p > 0.05, for all). CONCLUSION: PANDO is associated with chronic lymphoplasmacytic inflammation, fibrosis, and capillary proliferation within the lacrimal sac. These changes occur alongside inflammatory involvement of the adjacent nasal mucosa, while the nasal bone is typically spared. Among the three tissues examined, inflammation-related histopathological changes were most prominent in the lacrimal sac; however, no significant correlation was observed between the lacrimal sac and nasal mucosa regarding the severity of these changes.