Lymphoid tumours of the lacrimal drainage apparatus; a cohort review and analysis

Abstract

Purpose: To review and analyse lymphoid tumours involving the lacrimal drainage apparatus through retrospective review of an orbital surgeon's care across multiple centres; including incidence, clinical presentation, signs, radiological features and management. Method: Retrospective cohort analysis of ocular and adnexal lymphoproliferative disease (OALD) seen through Queensland orbital services between 1992 to 2024. Inclusion criteria were patients with histologically proven OALD. Three hundred and two OALD patients were identified, with 22 patients (7%) demonstrating involvement of the nasolacrimal drainage apparatus. Results: Fifty percent of patients presented with dacryocystitis, while 32% had a palpable mass and only 27% with epiphora. Thirty percent of patients had disease detected at the time of elective dacryocystorhinostomy surgery. No patients demonstrated haemolacria. Computed tomography findings included variable patterns of bony destruction and nasolacrimal duct obstruction. Magnetic resonance imaging, when utilised, better defined the extent of lesions; commonly/hyperintense on T1 and hypointense on T2 imaging. Histological review highlighted 38% (8) were diffuse large B-cell lymphoma, 18% (4) T-cell lymphoma, 14% (3) chronic lymphocytic or small lymphocytic lymphoma and 30% (7) other variants. Ann-Arbor lymphoma classification highlighted 30% (6) of patients with stage 1, with 60% (13) identified at Stage 3 or 4. Ten patients have achieved disease-free survival, with one patient requiring ongoing treatment. Three patients died as a result of OALD. Conclusion: OALD affecting the lacrimal drainage apparatus is an uncommon but serious differential of dacryocystitis. Symptoms can be highly variable; early detection, timely imaging and histological identification can meaningfully affect associated mortality.