Lacrimal System

 
 

Overview, Signs and Symptoms of an Obstruction

Congenital Nasolacrimal Duct Obstruction

The nasolacrimal duct is a duct that connects the lacrimal glands in the eye to the nasal cavity. In this article, we shall briefly review the epidemiology, clinical presentation and the common causes of this condition.

Epidemiology

 

Blockage simple obstruction
congenital fistula (as seen to the left)
acute dacryocystitis
congenital dacryocele or mucocele

Clinical presentation

Causes

Nasolacrimal duct obstruction is not very common but does have some recognised causes. The top three causes include –

It is commonly accompanied by other eye abnormalities.

Treatment

 

 

Acquired (ADULT-ONSET) Nasolacrimal Duct Obstruction

Epiphora is the overflow of tears which is caused by an imbalance in tear production and tear drainage. Other than conditions that cause an abnormal increase in tear production, an abnormality in tear drainage is the most likely cause of epiphora. It could be either functional due to a displaced punctum, eyelid laxity, weak orbicularis, or facial nerve palsy or an anatomical obstruction could block the drainage of tears. Anatomical obstruction of the nasolacrimal duct could be congenital which occurs during the neonatal period or acquired which manifests during adulthood.

Classification of Acquired Nasolacrimal Drainage Obstruction (NLDO)

Acquired nasolacrimal drainage obstruction could be primary or secondary.

Pathophysiology/Statistics

  1. Bacterial Causes – Most common causes are Actinomyces, Propionibacterium, Fusobacterium, Bacteroides, Mycobacterium, and Chlamydia.
  2. Viral Causes – Most commonly Herpes virus. Due to canalicular obstruction and damage.
  3. Fungal Causes - Aspergillus, Candida, Pityrosporum, and Trichophyton. Usually cause obstruction due to dacryolith/stone or cast formation.
  4. Parasitic Causes – Rare but can be caused by Ascaris lumbricoides entering through the valve of Hasner.

Inflammatory lacrimal drainage obstruction: May be endogenous or exogenous in origin.

Neoplastic lacrimal drainage obstruction: Neoplasms cause obstruction by primary growth, secondary spread, or metastatic spread.

Traumatic lacrimal drainage obstruction: May be iatrogenic or non-iatrogenic.

Mechanical lacrimal drainage obstruction

Symptoms/Presentation

On examination, the following findings could be present.

Investigations

Treatment

Medical Care

Surgical Care

 

 

wpe14.jpg (26191 bytes)wpe13.jpg (33766 bytes) The photo and CT on the left represents a nasolacrimal duct tumor which can result in a nasolacrimal duct obstruction.

Once the tumor was removed, silicone intubation performed, the patient's symptoms of tearing resolved