Tailored Surgical Management for Maxillary Sinus Fungus Ball-Induced Nasolacrimal Duct Obstruction: A Case Series and Literature Review

Abstract

Maxillary sinus fungus ball (MSFB)-induced nasolacrimal duct obstruction (NDO) is extremely rare, with nonspecific symptoms posing diagnostic and therapeutic challenges. Long-term MSFB causes nasolacrimal duct bone erosion via chronic inflammation-driven cytokine release and pressure necrosis, often leading to irreversible obstruction when the extent of bone destruction is extensive. We analysed two cases of MSFB-induced NDO (61-year-old female, 71-year-old male) with prolonged epiphora (20–24 months), CT-documented bone erosion and intraoperative severe fibrotic scarring, treated successfully with combined functional endoscopic sinus surgery (FESS) and dacryocystorhinostomy (DCR). A literature review identified two cases managed with FESS alone due to reversible NDO. This study proposes pre- and intraoperative criteria for distinguishing irreversible NDO, highlighting that individualised surgical strategies tailored to irreversible NDO resulting from extensive MSFB-induced bone destruction are essential. Such strategies, either FESS alone or combined with DCR based on comprehensive evaluation, effectively address the aetiology and functional sequelae of MSFB-related NDO.