Lacrimal obstruction in inflammatory bowel disease.

PURPOSE

To report lacrimal drainage obstruction in association with inflammatory bowel disease (IBD) in 9 patients.

METHODS

The clinical records of 461 consecutive adult patients treated for acquired lacrimal obstruction by dacryocystorhinostomy were reviewed. Patients with IBD were identified. Additional data collected included known secondary causes of lacrimal obstruction, a history of sinonasal disease, complications following lacrimal surgery, and demographic information.

RESULTS

Nine patients (7 women, 2 men) with a median presenting age of 61 years (range, 38-70 years) had IBD. Five patients had Crohn disease, and 4 patients had ulcerative colitis. Seven patients had nasolacrimal duct stenosis or obstruction, and 2 patients had lacrimal canalicular obstruction. Six patients (67%) reported symptoms of sinonasal disease. One patient reported intermittent tearing and nasal obstructive symptoms during flare-ups of bowel disease. All 9 patients were being treated with long-term oral 5-aminosalicylate agents prior to the onset of lacrimal symptoms. One patient had recurrent lacrimal obstruction, 1 year after initially successful surgery. No other surgical complications were observed. Excluding 1 patient with herpetic canalicular obstruction and Crohn disease, the proportion of patients undergoing dacryocystorhinostomy surgery identified to have IBD (1.7%) was significantly higher than the estimated prevalence of IBD in the Australian population (0.3%) (p < 0.0001).

CONCLUSIONS

In a large cohort of patients surgically treated for acquired lacrimal obstruction, the authors found an increased rate of IBD compared with the estimated population prevalence. To investigate this association further, the authors recommend obtaining lacrimal sac biopsies from patients with IBD who undergo dacryocystorhinostomy surgery.