INVITED COMMENTARY The etiologies of acute dacryocystitis are many; however, Previously in the literature intranasal variations and the final outcome is complete nasolacrimal duct stenosis pathology have contributed to the high occurrence of preventing drainage from the lacrimal sac to the nose. the chronic nature of this problem in women. The authors In chronic dacryocystitis there is distension of the sac here have supported this with measurements of the anato- with or without inflammation. Probing of the nasolacri- my. They should be acknowledged for this investigation mal system will not achieve patency in adults in this con- which may shed light into this gender difference. I do be- dition if the PANDO is more than 2±3 years. Surgery lieve, as the authors state, that further studies should be therefore must be undertaken. The understanding of undertaken to fully understand chronic dacryocystitis in why women are affected more than men have not been women. completely explored in the ophthalmic or plastic litera- ture. The authors of this paper allow us to appreciate F. Nesi ( ) ´ S. Myint Beaumont Hospital the nasal anatomic differences which may contribute to Royal Oak, MI, Providence Hospital chronic dacryocystitis in women. The findings seem to Southfield, MI show a statistical difference between the controls and 29201 Telegraph Rd. Suite 305 the affected patients. Southfield, MI 48034, USA AUTHORS' REPLY As we have stated in our paper, chronic dacryocystitis Chronic dacryocystitis, therefore, is seen more frequently may be caused by many disorders including septal devia- in Turkish women with smaller noses and the incidence is tion, abnormalities of the inferior concha, infections of higher than the males. nasal and paranasal region, maxillofacial fractures and We suggest that nasal dimensions and indexes should conjunctival infections. be studied in various groups of patients from different eth- Although such nasal pathologies exist in many people, nic origin, and from different sexes; this would possibly the majority do not develop chronic dacryocystitis. We contribute to our understanding that nasal dimensions believe that narrowness of the nasal passages is not the and indexes are predisposing factors for the development only causative factor for the development of chronic da- of chronic dacryocystitis in different sexes. cryocystitis, however, once accompanied with the nasal and paranasal pathologies, the disease becomes more like- ly to develop; this fact is further supported by our study. H. Dogan Erciyes University Faculty of Medicine As Avasthi and co-workers have pointed out, the inci- Department of Ophthalmology dence of chronic dacryocystitis is high in subjects with Kayseri brachycephalic skulls [10]. Turkish people also belong Turkey to the ethnic group having brachycephalic skull structure. Fax: +90 3524374931 European Journal of Plastic Surgery Springer Journals


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Copyright © 1999 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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