Histological Characteristics of Patients with Chronic Dacryocystitis, Depending on the Presence of Advanced Dacryolithiasis

Abstract

Background Dacryoliths (DL) are found in up to 18% of patients with chronic dacryocystitis (CDC). In particular, the role of neutrophil granulocytes in stone development needs to be clarified.

Material and Methods 40 histological specimens from patients with CDC and existing lacrimal sac ectasia were examined. For this purpose, sections of the medial saccus wall were obtained during a transcutaneous dacryocystorhinostomy. Twenty samples showed CDC without DL (group 1), 20 patients showed advanced dacryolithiasis (group 2). The histological criteria (inflammation, fibrosis, lymphocytes, plasma cells, macrophages, neutrophil granulocytes) were scored (0 = not present; 1 = few; 2 = moderate; 3 = numerous/strongly pronounced).

Results The gender ratio was balanced (1 : 1; 10 female and 10 male patients per group) and the age difference between groups 1 and 2 was not significant (median 53 vs. 56 y; p = 0.482). The histological parameters showed no significant differences between groups 1 and 2 (inflammation: 39/36, p = 0.292; fibrosis: 21/20, p = 0.385; lymphocytes: 37/32, p = 0.149; plasma cells: 25/24, p = 0.407; macrophages: 19/17, p = 0.152; neutrophil granulocytes: 10/13, p = 0.197).

Conclusions The histological changes in the medial lacrimal sac wall are not dependent on the presence of dacryoliths. In particular, the presence of neutrophilic granulocytes is not increased in patients with long-standing dacryolithiasis.

Conclusion Box

What we already know:

• Chronic dacryocystitis is associated with dacryolithiasis in up to 18% of cases.

• Numerous proteins specific for neutrophils occur within the concretions. Neutrophils themselves are also present in some of the concretions.Neutrophils thus play a role in dacryolithogenesis.

Newly described:

• Chronic dacryocystitis in patients with and without dacryoliths exhibits a chronic fibrosing inflammation, with similar pathohistological morphology observed in both groups.

• In chronic dacryocystitis with advanced dacryolithiasis, there are no differences in the incidence of neutrophils compared to chronic dacryocystitis without calculi.

Fazitbox

Bereits bekannt:

• Eine chronische Dakryozystitis geht in bis zu 18% mit einer Dakryolithiasis einher.

• Innerhalb der Konkremente kommen zahlreiche, für neutrophile Granulozyten spezifische, Proteine vor. In einem Teil der Konkremente kommen auch Neutrophile selbst vor. Neutrophilen Granulozyten kommt somit eine Rolle im Rahmen der Dakryolithogenese zu.

Neu beschrieben:

• Die chronische Dakryozystitis bei Patienten mit und ohne Dakryolithen zeigt eine chronisch-fibrosierende Entzündung, wobei sich die pathohistologische Morphologie in beiden Gruppen gleicht.

• Bei einer chronischen Dakryozystitis mit fortgeschrittener Dakryolithiasis findet man im Vergleich zur chronischen Dakryozystitis ohne Steinleiden keine Unterschiede hinsichtlich des Vorkommens neutrophiler Granulozyten.

Keywords

chronic dacryocystitis - dacryoliths - dacryocystorhinostomy - histology - inflammation - neutrophil granulocytes

Publication History

Received: 20 February 2025

Accepted: 10 June 2025

Article published online:
01 September 2025

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