Tumours of the Lacrimal Drainage System

Tumours of the lacrimal drainage system (LDS) are rare and potentially life-threatening, and so early diagnosis and treatment are critical. Primary benign and malignant tumours can arise from the many types of cells within the LDS, such as the various epithelial linings, goblet cells, melanocytes, mesenchymal cells, and lymphoid tissues. These tumours can be classified into epithelial and non-epithelial subtypes, with primary epithelial tumours accounting for about 75% of all LDS neoplasia (approximately two-thirds of which are malignant), and non-epithelial tumours accounting for approximately a quarter. Papilloma is the commonest benign tumour, and about 90% of malignant tumours are of epithelial origin, with squamous cell carcinoma accounting for more than half of these malignancies. Most patients with LDS tumours present insidiously with symptoms related to chronic dacryostenosis or dacryocystitis, although over 40% of lacrimal sac tumours may be found incidentally at the time of dacryocystorhinostomy. A firm mass located or extending above the medial canthal tendon is strongly suggestive of tumour, with a three-quarters likelihood of malignancy. A high index of clinical suspicion, early imaging studies, a low threshold for biopsy, and a thorough systemic evaluation are critical. The management of LDS tumours requires a multidisciplinary approach, with wide local excision after incisional diagnostic biopsy being the mainstay of treatment for most tumours, although radiotherapy and chemotherapy can be used for some tumour types and dependent upon the stage. All LDS tumours require lifelong monitoring, as recurrence and metastasis can occur many years after initial treatment.