Lacrimal drainage pathway disease-associated keratopathy effectively diagnosed with dacryoendoscopy: a report of two cases.

Background: We described two cases of lacrimal drainage pathway disease-associated keratopathy (LDAK) wherein lacrimal irrigation tests revealed no abnormalities, and there were few signs and symptoms suggestive of lacrimal drainage pathway disease.

Case presentation: Case 1 involved a 66-year-old woman with Sjögren's syndrome who presented with corneal perforation in her left eye. Slit-lamp examination revealed a non-infiltrative corneal ulcer and perforation in the inferior peripheral cornea. LDAK was suspected; however, there were minimal signs of lacrimal drainage pathway disease. Despite treatment with contact lenses and topical steroids, there was no improvement. Dacryoendoscopy was performed, revealing multiple concretions within the canaliculus. LDAK caused by lacrimal canaliculitis was confirmed, and the corneal ulcer rapidly re-epithelialized after removing the concretions. Case 2 involved a 78-year-old woman with Sjögren's syndrome who presented with epiphora in her right eye. Slit-lamp examination revealed two non-infiltrative ulcers in the inferior cornea, one of which had perforated. LDAK was suspected, but there were minimal signs of lacrimal drainage pathway disease. Dacryoendoscopy was performed, revealing concretions within the lacrimal sac and confirming chronic dacryocystitis. After removing the concretions, the corneal ulcer rapidly re-epithelialized.

Conclusions: We encountered two cases of LDAK that presented with minimal signs of lacrimal drainage pathway disease. When LDAK is suspected, dacryoendoscopy is a valuable tool for diagnosing lacrimal drainage pathway disease and removing concretions.