Endoscopic features of lacrimal sac in a case of lichen planus

Excerpt

Lichen planus is an autoimmune disease that predominantly affects skin and mucous membranes. A female patient, aged 45 years, presented with bilateral epiphora of 6 months duration. She was diagnosed with cutaneous lichen planus 5 years ago, well controlled on topical medications. Examination of the lacrimal system was suggestive of bilateral nasolacrimal duct obstruction with evolving punctal stenosis. There was no history of trauma or any episodes of infections. A right endoscopic dacryocystorhinostomy was performed. Lacrimal sac marsupialization was found to be difficult because of the fibrous consistency of the sac wall. Once the flaps were reflected (black star, Fig. 1a), multiple firm mucosal and submucosal projections arising from the walls (black arrows, Fig. 1a) were noted to project into the lumen (‘L,’ Fig. 1a). These were more numerous in the fundus and upper half of the lacrimal sac as compared to the lower half. Few intervening flat and pale areas of submucosal fibrosis were noted (pale patch beside ‘L,’ Fig. 1a). Endoscopic biopsies were performed from two prominent projections. Puncta were dilated. Mitomycin C (0.02%, 3 min) and bicanalicular intubation were performed. Endoscopic dacryocystorhinostomy was completed uneventfully. Postoperatively, patient was on topical ocular and nasal steroids for a month. At 3 months follow-up, the patient was symptom free, and ostium was healthy and patent. Left-sided surgery is being planned after 3 months.

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