Lacrimal sac diverticulum: clinical presentation and endoscopic management

Eur Arch Otorhinolaryngol. 2022 Jan;279(1):199-203. doi: 10.1007/s00405-021-06773-x. Epub 2021 Mar 27.


Background: To describe the clinical presentation, surgical intervention and clinical outcomes of patients with a lacrimal sac diverticulum.

Methods: Retrospective chart review of all patients who underwent endonasal endoscopic dacryocystorhinostomy (DCR) in a single medical center from January 2010 to October 2020. The diagnosis of a lacrimal sac diverticulum was based upon intraoperative findings.

Results: In total, 406 patients underwent endonasal endoscopic DCR during the study period. Eight female patients (mean age 35 years) were diagnosed with a lacrimal diverticulum and underwent DCR by an endonasal endoscopic approach. The mean follow-up period was 11.5 months. All eight patients had cystic findings at the lacrimal fossa on imaging studies prior to surgery. Five patients had a history of dacryocystitis. The main presenting symptoms were epiphora and/or medial canthal swelling. The diverticulum was identified on the inferior wall in seven cases. A dacryolith in the lacrimal sac was identified intraoperatively in two patients. All patients showed full resolution of symptoms after surgery. There were no intraoperative or postoperative complications.

Conclusion: Lacrimal sac diverticulum is a rare entity with female predominance. It may be the underlying etiology of epiphora and/or dacryocystitis. The diagnosis is based upon identifying the presence of a diverticulum intraoperatively. Endoscopic DCR is an effective approach for integrating both the lacrimal sac and diverticulum cavities into a single space, leading to resolution of symptoms.

Keywords: Dacryocystitis; Dacryocystorhinostomy; Diverticulum; Endoscopic; Lacrimal sac.

MeSH terms

  • Adult
  • Dacryocystitis* / surgery
  • Dacryocystorhinostomy*
  • Diverticulum* / diagnosis
  • Diverticulum* / diagnostic imaging
  • Endoscopy
  • Female
  • Humans
  • Lacrimal Apparatus Diseases* / diagnosis
  • Lacrimal Apparatus Diseases* / surgery
  • Nasolacrimal Duct* / diagnostic imaging
  • Nasolacrimal Duct* / surgery
  • Retrospective Studies
  • Treatment Outcome