Types of lacrimal gland obstruction differ by gender

Primary lacrimal drainage system obstruction is vastly more common in women compared with men, and traumatic obstruction is more prevalent among young male patients (70%), according to Lisia Aoki, MD, from the Department of Ophthalmology, University Hospital, São Paulo, Brazil.

The investigators retrospectively studied 163 cases of lacrimal gland obstruction with the goal of determining the epidemiologic profile of the patients admitted to the Oculoplastics Department of the University of São Paulo Medical School. The study was conducted from July 2002 to July 2004 and the effect of age, sex, race, and the etiology of the lacrimal gland obstruction were evaluated.

Patient ages ranged from 4 months to 88 years (mean, 38 years), with most patients over 60 years of age. The majority (63%) were women (103 women, 60 men). The mean age of the men was 29.4 years, with a high incidence of cases in patients aged 0 to 30 years. Traumatic obstruction was more common in young men, which lowered the mean age of the men. Among the women, the mean age was 60 years and most cases were primary lacrimal obstruction, resulting in an increase in the mean age. There was no difference in gender among the cases of patients aged 0 to 10 years, with almost all cases congenital in nature, Dr. Aoki reported.

Of all patients, 70% were Caucasian, 18% mulatto, 3% African-American, and 1% Asians. Mulatto patients presented with primary and congenital obstructions in equivalent proportions; this differed from the Caucasian patients who presented mostly with primary disease. During the interview, most patients reported multiple symptoms, with epiphora the most common complaint and mentioned by 131 patients, followed by secretion mentioned by 63 patients. Acute and chronic dacryocystitis were reported by 27 and 33 patients, respectively. Mucocele was reported by only 21 patients.

"The most common etiology of lacrimal obstruction was primary, which was found in 81 cases (50%). This was followed by congenital and traumatic obstruction in 40 (24.5%) and 27 (16.5%) cases, respectively. Sinusitis pathology was less common and occurred in 5% of cases," Dr. Aoki reported.

There was also one case each of Wegener's granulomatosis, comprehensive lacrimal obstruction by basal cell carcinoma, and obstruction resulting from ocular cicatricial pemphigoid.

The traumatic obstruction cases were more prevalent among male patients (70%), with a mean age of 28.6 years. Primary lacrimal obstruction was more common among women (82.7%), with a mean age of 55.6 years. The higher prevalence of primary lacrimal obstruction in women is partly explained by anatomic features because the nasolacrimal gland is narrow and the bone smaller.