Rom J Morphol Embryol 2017, 58(2):537–544 ISSN (print) 1220–0522 ISSN (online) 2066–8279 ORIGINAL PAPER A 16-year retrospective study of dacryocystitis in adult patients in the Moldavia Region, Romania CLAUDIA FLORIDA COSTEA 1,2) , GABRIELA FLORENŢA DUMITRESCU 3) , MIHAELA DANA TURLIUC 4,5) , GABRIELA DIMITRIU 2) , MĂDĂLINA ADRIANA CHIHAIA 2) , LUCIA INDREI 6) , NICOLETA DUMITRESCU 7) , ANDREI CUCU 5) , ALEXANDRU CĂRĂULEANU 8) , CRISTINA MARIA GAVRILESCU 9) , IRINA IULIANA COSTACHE 9) 1) Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 2) 2 nd Ophthalmology Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iaşi, Romania 3) Laboratory of Pathology, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iaşi, Romania 4) Department of Neurosurgery, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 5) 2 nd Neurosurgery Clinic, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iaşi, Romania 6) 2 nd Year Student, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 7) 3 rd Year Student, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 8) Department of Obstetrics and Gynecology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania 9) 1 st Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania Abstract Purpose: Chronic dacryocystitis (CD) is an inflammation of the lacrimal sac and nasolacrimal duct with a long-standing evolution. The aims of this study were to analyze the epidemiology and to evaluate the histopathological features and the chronic inflammation score (CIS) system of chronic dacryocystitis in the region of Moldavia, Romania, over a period of 16 years. Methods: We conducted a retrospective descriptive analysis of all pathological reports of chronic dacryocystitis from the Department of Pathology, “Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, Iaşi, Romania, between January 1, 1999 and December 31, 2015, with the final application of CIS. We also recorded the demographic information of patients and lesion localizations. Results: Eighteen cases of CD were identified, with a female:male ratio of 8:1. Patient median age was 66.27 years (range 33–83 years), 55.55% being in their eighth and ninth decade of life. A non-systemized growth trend starting with 2002 could be identified. Microscopically, several histopathological features were identified, some of them being associated: epithelial lining hyperplasia with pseudopapillary folds (77.77% of the cases), epithelial invaginations in the submucosa (11.11%), squamous metaplasia (16.66%) or partial denudation (33.33%). The sac wall revealed chronic diffusion (88.88%) or nodular lymphocytic inflammation (11.11%). 5.55% of cases presented fibrosis in the lacrimal sac wall with few lymphocytes. Applying CIS system, the majority of cases (13 patients, 72.22%) were identified with moderate chronic inflammation, only one case (5.55%) pointed out a mild degree of inflammation with a CIS<3, but four (22.22%) cases showed severe inflammatory changes with a CIS>6. Conclusions: In our region, CD is more frequent in senior women, probably due to their deficient immune system. Histological specimens of CD are not commonly found in practice of pathologists, but when the histological sections are analyzed they reflect a multitude of aspects that need to be known in order to guide ophthalmologists in their practice. In our region, CD is more frequent in senior women, probably due to their deficient immune system and to the specific anatomy of their nasolacrimal duct. The histological appearances varied from patient to patient and even in the same patient varied from one area to another. There were histopathological changes indicating adaptive changes, which could lead to the development of malignant tumors at this level. Therefore, there is a need for patient education with CD both in terms of ophthalmic hygiene and in what regards possible complications in the absence of a regular presentation to the ophthalmologist. Keywords: chronic dacryocystitis, epidemiology, epithelial hyperplasia, squamous metaplasia, chronic inflammation score.  Introduction The diseases of lacrimal drainage system represent only 3% of all visits to Ophthalmology clinics [1]. Among all these disorders, dacryocystitis distinguishes itself as a frequent lesion and represents an inflammation of the lacrimal sac and nasolacrimal duct caused by the spread of microorganisms from the conjunctiva or the nasal mucosa. Usually, this disease is associated with the functional or anatomical obstruction of the nasolacrimal duct, as the lacrimal sac distensions due to the accumu- lation of tears and mucous secretions provide an environ- ment for conjunctival flora growth [2]. In specimens of dacryocystorhinostomy and dacryocystectomy sent by the ophthalmologist to the Department of Pathology is commonly diagnosed non-granulomatous inflammation, but benign epithelial tumors (papilloma) or malignant epithelial tumors (transitional cell carcinoma, adeno- carcinoma, undifferentiated carcinoma, mucoepidermoid carcinoma) could be rarely identified and lymphoid tumors (non-Hodgkin’s B-cell lymphoma), leukemic infiltration, plasmacytoma, or oncocytoma are very rare [3, 4]. However, dacryocystitis is the most common pathology of the lacrimal drainage system, representing 79–87% of all lesions (tumoral and non-tumoral) at this level [3, 5]. In this study, we aim to analyze the epidemiology and to evaluate the histopathological features and the chronic inflammatory score (CIS) system of chronic dacryocystitis R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/