PURPOSE: To determine the frequency of histologically verified lesions of the lacrimal drainage system in Denmark between the years 1910 and 1999. Furthermore, to correlate the clinical diagnosis with the pathology diagnosis. METHODS: Retrospective review of all pathology reports from 1910 to 1999 in the files of the Eye Pathology Institute, University of Copenhagen, describing a lesion of the lacrimal drainage system. In addition, a retrospective review of all reports describing a lesion of the lacrimal drainage system from the Danish Pathology Database. All specimens were re-evaluated, except in cases with a primary diagnosis of dacryocystitis. In these cases a sample of 25% was re-evaluated. RESULTS: A total of 643 lesions were collected. Dacryocystitis was the most frequent lesion, constituting 508 cases (79%). The remaining cases were diagnosed as dacryolithiasis (62 cases; 7.9%), tumour (29 cases; 4.5%), trauma (19 cases; 3.0%), congenital malformation (nine cases; 1.4%), canaliculitis (eight cases; 1.2%) and granulomatous inflammation (eight cases; 1.2%). Seventeen tumours were malignant, of which B-cell lymphoma was the most common (six cases). In 0.6% of cases with a clinical diagnosis of dacryocystitis/lithiasis a non-suspected malignant tumour was diagnosed. Micro-organisms were uncommon in dacryocystitis (9%) but frequent in cases of dacryolithiasis (87%). CONCLUSION: Dacryocystitis was by far the most frequent lesion of the lacrimal drainage system referred for histopathological evaluation. Dacryolithiasis was often associated with micro-organisms, especially Gram positive rods. Histopathology is necessary to confirm suspected tumours, more than half of which were inflammatory lesions, and to detect tumours that sometimes masquerade as inflammation.
Investigations were carried out on 102 consecutive medicolegal post-mortem subjects to identify signs of focal adenitis in labial, submandibular, and lacrimal glands. There were 19 subjects (18.6%) with focus scores exceeding 1 in one or two of the types of glands. Among the 19, five had had a disease which is generally associated with Sjögren's syndrome or is autoimmune in nature. In another 63 subjects occasional lymphocytic foci were found in one, two, or all three types of gland. Fibrosis, atrophy, and fatty change had occurred most often in the labial salivary glands in those over 50 years of age with or without high focus scores. Fibrosis, atrophy, and fat infiltration had hardly ever occurred in the lacrimal glands, although this is the type of gland in which high focus scores occur most often. The results suggest that there may be a common autoimmune basis for Sjögren's syndrome and other diseases, the mechanisms of which are still incompletely understood. A focus score exceeding 1 may be an indicator of Sjögren's syndrome, but the diagnosis should not be established on the biopsy findings alone.