Surgical management of nasolacrimal duct obstruction in patients with Wegener's granulomatosis.

The treatment of symptomatic nasolacrimal duct obstruction in patients with Wegener's granulomatosis is controversial. Dacryocystorhinostomy has been effective in patients with long-standing quiescent disease but has been complicated by the formation of nasal-cutaneous fistulas in others. Dacryocystectomy may be an alternative if epiphora is absent. The authors report 13 lacrimal bypass surgeries in 9 patients with Wegener's granulomatosis; there were 10 operations with adequate follow-up and 6 surgical successes. Failure was related to a history of dacryopyocele, localized disease activity in the nose and upper airway, extensive periorbital disease, the use of non-maintenance therapy to contain disease activity, and prior surgical failure. The authors' experience suggests that dacryocystorhinostomy is therapeutically viable in patients with Wegener's granulomatosis; intervention is optimal when the disease is quiescent without medication and is probably reasonable if activity is controlled with maintenance therapy. Anticytoplasmic antibody titers are useful to guide the timing of elective surgery.