Rare tear duct cancer treated, eye preserved

Pune: A 50-year-old man from Satara with an exceptionally rare and locally advanced cancer of the nasolacrimal apparatus — the tear drainage system connecting the eye to the nasal cavity — was successfully treated at the Apollo Hospitals Pune through a complex surgery that preserved his left eye despite the tumour’s proximity.Doctors said the patient initially had persistent watering of the left eye and swelling near its inner corner, symptoms that appeared routine at first. He had undergone a failed tear duct drainage surgery and chemoradiation elsewhere before being diagnosed with cancer of the tear duct. However, the disease recurred aggressively within three months.The cancer had spread significantly by the time the patient reached the Pune hospital. The tear sac near the left eye was affected, damaging nearby bone structures and extending towards the base of the skull. Tests also revealed a second tumour in the nasal septum, making the case more complicated.Dr Vidita Powle, senior consultant and head and neck surgical oncologist at Apollo Hospitals Pune, said, “What began as a seemingly simple eye complaint masked one of the rarest cancers. The disease had progressed aggressively and involved structures very close to the eyeball. Our priority was complete tumour clearance, while preserving the eye and restoring the patient’s quality of life.”A multidisciplinary team led by Powle performed an eight-hour surgery involving extensive tumour removal, maxillectomy, neck dissection and advanced reconstruction using a microvascular free flap. Despite the tumour being close to the eye, surgeons managed complete removal while preserving vision.The patient was discharged within a week with good functional outcomes, doctors said.Hospital officials said cancers of the nasolacrimal apparatus are uncommon and presentations involving a second primary tumour in the same region are considered especially rare.Doctors said persistent eye watering or swelling near the inner corner of the eye that does not improve with treatment should not be ignored and may warrant further investigation.