Intraoperative identification of lacrimal sac by means of methylene blue

Abstract

Methylene blue (MB) has many uses in medicine, being applied as a treatment for infections, malaria, methemoglobinemia, as a dye for diagnosis and for staining of cells, tissues and bacteria. In elderly patients with associated high anaesthetic risk, dacryocystectomy is an alternative to dacryocystorhinostomy. This is an observational clinical study for two cases of chronic dacryocystitis where dacryocystectomy combined with MB (1%) staining of lacrimal sac was performed. Case no.1-an 81-year old female patient with arterial hypertension, atherosclerosis, pulmonary fibrosis, and lower limb varices complainted of recurrent epiphora, muco-purulent secretions in both eyes, inflammatory oedema of the left perisacular region for the past 6 months. Case no. 2-a 74-year old female patient with hypothyroidism suffered from chronic epiphora in the left eye with a purple-red oedema of the inferior eyelid and perisacular region. Symptoms reoccurred in the last 10 months despite topical and systemic therapy with antibiotics and anti-inflamatory drugs. Dacryocystectomy was performed under local anaesthesia in both patients. MB (1%) was used to irrigate the lacrimal sac in order to facilitate its localisation, dissection and excision. Results: Case no.1. Ectopic lacrimal sac. Case no.2. Enlarged lacrimal sac (7.5/14 mm). The histopathological examination revealed a trachomatous dacryocystitis, respectively a chronic non-suppurative non-granulomatous dacryocystitis. Their postoperative evolution was without complications, except for a mild epiphora. In conclusion, dacryocystectomy appears to be a less traumatising alternative to dacryocystorhinostomy. The staining of the lacrimal sac with MB (1%) in dacryocystectomy facilitates its identification and dissection, especially when it is ectopic.