Dacryoliths in the lacrimal gland ductule

Purpose Lacrimal duct obstruction can occasionally be associated with dacryolithiasis. Dacryoliths (DLs) have been found in the nasolacrimal sac, nasolacrimal duct, canaliculi, and rarely in the lacrimal gland ductules. Here, we would like to present the clinical, intra‐operative, and histologic findings in 4 cases of DLs in the lateral fornix Methods All 4 patients were examined by slit lamp microscopy, and ultrasound (US) was performed in 3 patients; 1 patient underwent Magnetic resonance imaging (MRI). Following surgery, the excised tissue and concretions were fixed in formalin and embedded in paraffin. Ophthalmopathologic examination included routine staining with H&E and PAS as well as stains for microorganisms. Results All patients presented with a short duration of symptoms with only little pain. Lesions were located at the lateral canthus and appeared slightly hyperemic and to a varying degree cystic. US showed hypo‐ and hyperreflective signals but did not demonstrate any concretions. The DLs were found intraoperatively during removal of the "tumour". Macroscopic characteristics varied between small multiple round whitish–yellow concretions of hard consistency (0.7mm in diameter) and bigger more irregular stones (up to 7mm). Histology revealed amorphous acellular material without any evidence of microorganisms. In one patient, a cilium was found. All symptoms resolved quickly after removal of the DLs. Conclusion DLs of the lacrimal system can – albeit rarely – form in the excretory duct of the lacrimal gland. Possible agents responsible for stone formation in the lacrimal gland ductule include cilia and – less likely ‐ bacteria. Both US and MRI appear ineffective in reliably identifiying dacryoliths at this site but surgical intervention leads to rapid relief of all symptoms.