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Malignant neoplasm of nasolacrimal duct — Clinical Guidelines

Overview

Malignant neoplasm of the nasolacrimal duct is a rare and aggressive condition involving cancerous growth within the lacrimal drainage system, often presenting with epiphora, ocular pain, and potential spread to adjacent structures. 13

Diagnosis

Clinical Presentation: Epiphora, ocular pain, and signs of systemic malignancy. 13

Diagnostic Tests:

- Nasal Endoscopy: Utilized for detailed visualization of the nasolacrimal duct and surrounding structures. 2 - Lacrimal System Imaging: Digital dacryocystography and other imaging modalities may help identify obstructions or masses. 15 - Biopsy: Essential for histopathological confirmation of malignancy. 13

Management

Surgical Interventions:

- Dacryocystorhinostomy (DCR): Endoscopic or external approaches for obstructive lesions; often combined with mitomycin C to enhance success rates. 4 9 10 - Intubation: Use of stents (e.g., monocanalicular stents) in pediatric cases under sedation outside the operating room. 3

Adjuvant Therapies:

- Mitomycin C: Applied during DCR to reduce scarring and improve patency. (Evidence: Strong) 4

Special Populations

Pediatrics: Probing and intubation are common initial treatments, with sedation used outside the operating room for stent placement. 3

Elderly: Management may involve more conservative surgical approaches due to comorbidities; endoscopic techniques are increasingly favored for their minimally invasive nature. 9 10

Key Recommendations

Perform Nasal Endoscopy for detailed evaluation of nasolacrimal duct obstructions and suspected malignancies. (Evidence: Moderate) 2

Consider Mitomycin C during dacryocystorhinostomy procedures to improve anatomical and functional outcomes. (Evidence: Strong) 4

Use Endoscopic DCR as an effective alternative to external DCR, particularly in managing nasolacrimal duct obstructions with malignancy. (Evidence: Moderate) 9 10

In pediatric cases, employ lacrimal probing and intubation under intravenous sedation outside the operating room for stent placement. (Evidence: Moderate) 3

References

1 Khiyani AR, Mohanty P. "SYRI" - A hands-on teaching model for SYRInging of nasolacrimal duct. Indian journal of ophthalmology 2025. link 2 Rehman O, Das S, Nowak R, Ali MJ. The Use of Hand-Held Digital Otoscope as a Basic Nasal Endoscopy Tool for Lacrimal Evaluation and Pedagogy Instrument. Current eye research 2024. link 3 Henry WA, Dalabih A, Grigorian AP. Pediatric nasolacrimal duct intubation using deep sedation outside the operating room- comparison of three types of stents. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2024. link 4 Freitag SK, Aakalu VK, Foster JA, McCulley TJ, Tao JP, Vagefi MR et al.. Use of Mitomycin C in Dacryocystorhinostomy: A Report by the American Academy of Ophthalmology. Ophthalmology 2023. link 5 Morrison DG, Binenbaum G, Chang MY, Heidary G, Trivedi RH, Galvin JA et al.. Office- or Facility-Based Probing for Congenital Nasolacrimal Duct Obstruction: A Report by the American Academy of Ophthalmology. Ophthalmology 2021. link 6 Zuazo F, Morales OO, Tovilla ML, Castañeda ÁN. Management of Congenital Nasolacrimal Duct Obstruction with Probing, Experience in a Mexican Eye Center. Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH 2019. link 7 Wladis EJ, Aakalu VK, Yen MT, Bilyk JR, Sobel RK, Mawn LA. Balloon Dacryoplasty for Congenital Nasolacrimal Duct Obstruction: A Report by the American Academy of Ophthalmology. Ophthalmology 2018. link 8 Galindo-Ferreiro A, Palencia-Ercilla T, Ferreira LM, Galvez-Ruiz A, Zornoff DCM, Khandekar R et al.. A survey of management of congenital nasolacrimal duct obstruction by pediatric primary health care providers in Spain. European journal of ophthalmology 2017. link 9 Kamal S, Ali MJ, Nair AG. Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center. Indian journal of ophthalmology 2016. link 10 Duwal S, Saiju R. Outcomes of external dacryocystorhinostomy and endoscopic endonasal dacryocystorhinostomy in the management of nasolacrimal duct obstruction. Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH 2015. link 11 Dotan G, Nelson LB. Congenital nasolacrimal duct obstruction: common management policies among pediatric ophthalmologists. Journal of pediatric ophthalmology and strabismus 2015. link 12 Schellini SA, Ariki CT, Sousa RL, Weil D, Padovani CR. Management of congenital nasolacrimal duct obstruction--latin american study. Ophthalmic plastic and reconstructive surgery 2013. link 13 Sibley D, Norris JH, Malhotra R. Management and outcomes of patients with epiphora referred to a specialist ophthalmic plastic unit. Clinical & experimental ophthalmology 2013. link 14 Sener EC, Onerci M. Reappraisal of probing of the congenital obstruction of the nasolacrimal system: is nasal endoscopy essential?. International journal of pediatric otorhinolaryngology 2001. link00469-9) 15 Müllner K, Bodner E, Mannor GE. Endoscopy of the lacrimal system. The British journal of ophthalmology 1999. link 16 Conway ST. Evaluation and management of "functional" nasolacrimal blockage: results of a survey of the American Society of Ophthalmic Plastic and Reconstructive surgery. Ophthalmic plastic and reconstructive surgery 1994. link 17 Singh AD, Singh A, Whitmore I, Taylor E. Endoscopic visualisation of the human nasolacrimal system: an experimental study. The British journal of ophthalmology 1992. link 18 Dryden RM, Popp JC. Visualization of the probe tip during lacrimal outflow system probing and intubation. Ophthalmic surgery 1985. link 19 Wobig JL. Lacrimal probing complications. Ophthalmic plastic and reconstructive surgery 1985. link

Malignant neoplasm of nasolacrimal duct