stenosis of lacrimal passage

Stenosis of the Lacrimal Passage

Stenosis of the lacrimal passage, also known as punctal stenosis or dacryostenosis, is a condition characterized by the narrowing or occlusion of the external opening of the lacrimal canaliculus. This leads to a blockage in the tear drainage system, causing tears to accumulate and overflow onto the eye.

Causes and Symptoms

The causes of stenosis of the lacrimal passage are varied and may include:

• Congenital conditions
• Acquired conditions due to trauma or inflammation
• Aging-related changes

Symptoms of stenosis of the lacrimal passage typically include excessive tearing, epiphora (watery eyes), and ocular discharge. In some cases, patients may also experience redness and irritation of the eye.

Diagnosis

Diagnosis is usually made through a combination of clinical evaluation and imaging studies, such as optical coherence tomography (OCT). The condition can be diagnosed when the punctum is less than 0.3 mm in diameter [10].

Treatment Options

Treatment options for stenosis of the lacrimal passage depend on the underlying cause and severity of the condition. In some cases, dilation or surgical intervention may be necessary to restore normal tear drainage.

• Dilation: A procedure where a small instrument is used to widen the blocked punctum.
• Surgery: May involve creating an adequate opening while maintaining the position of the punctum against the lacrimal lake and preserving the lacrimal pump function [9].

Prevalence

Stenosis of the lacrimal passage, also known as nasolacrimal duct obstruction (NLDO), is a relatively common condition affecting approximately 6% to 20% of newborns [11]. It typically presents in the first weeks or months of life with symptoms beginning when normal tear production occurs.

Definition and Staging

There are inconsistencies in the definition and staging of punctal stenosis. Advanced optical coherence tomography imaging techniques have revolutionized the way the punctum and vertical canaliculi are assessed or monitored following treatment [14].

Symptoms of Lacrimal Passage Stenosis

Lacrimal passage stenosis, also known as punctal stenosis, is a condition where the external opening of the lacrimal canaliculus (punctum) becomes narrowed or occluded. This can lead to various symptoms, including:

• Excessive tearing: The most common symptom of lacrimal passage stenosis is excessive tearing, which can be constant and severe [10].
• Watery eyes: A blocked tear duct can cause watery eyes and a sticky white or yellow discharge [7].
• Painful swelling: Some people may experience painful swelling near the inside corner of the eye due to lacrimal passage stenosis [5].
• Redness and irritation: The affected eye may appear red and irritated, especially in cases where the condition is accompanied by dacryocystitis [3].

Other Possible Symptoms

In some cases, lacrimal passage stenosis can be associated with other symptoms, such as:

• Mucus or yellowish discharge: A blocked tear duct can cause mucus or a yellowish discharge to drain from the eye [9].
• Eye redness and darkening: The skin around the affected eye may become red and darken due to inflammation [6].

Important Note

It's essential to seek medical attention if you experience any of these symptoms, as they can be indicative of a more serious underlying condition. A healthcare professional can diagnose lacrimal passage stenosis through a physical examination and further testing.

References:

[1] Context result 14 [3] Context result 3 [5] Context result 5 [7] Context result 7 [9] Context result 9 [10] Context result 10

Treatment Options for Lacrimal Passage Stenosis

Lacrimal passage stenosis can be treated with a combination of medical and surgical interventions. Here are some treatment options:

• Topical antibiotics: For early infections, topical antibiotics may be sufficient to clear up the infection. This can be combined with lacrimal massage to help clear blockages in the tear ducts [1].
• Systemic antibiotics: In cases of more chronic or severe infections, systemic antibiotics may be necessary to treat the underlying infection [1].
• Topical steroids: Topical steroids such as fluorometholone can be used to reduce inflammation and promote healing in the lacrimal passage. This can also help prevent scarring and promote drainage [6].
• Antiviral drops: In cases where a viral infection is suspected, antiviral drops may be prescribed to help clear up the infection.
• Surgical intervention: In more severe cases of stenosis or when other treatments have failed, surgical intervention may be necessary. This can include procedures such as dilation, probing and irrigation [5].

Less invasive treatments

Before considering surgery, your healthcare provider may recommend less invasive treatments such as:

• Warm compresses: Applying warm compresses to the affected area can help loosen blockages in the tear ducts.
• Massage: Massaging the lacrimal sac can also help clear blockages and promote drainage.
• Antibiotics for infection: If an infection is present, antibiotics may be prescribed to treat the underlying cause.

References

[1] Jun 16, 2023 — Topical antibiotics with lacrimal massage may be adequate for early infections. Systemic antibiotics may be necessary for more chronic or severe infections. [6] by B Lu · 2014 · Cited by 2 — Low concentrations of fluorometholone can inhibit the formation of scar tissue during the corneal wound healing process, aid in the repair process of the ... [5] One of the simpler approaches to treating a blocked tear duct is a three-step technique called dilation, probing and irrigation. This technique can help babies ...

The differential diagnosis of stenosis of the lacrimal passage involves considering various conditions that can cause narrowing or obstruction of the tear drainage system. Here are some possible causes:

• Congenital nasolacrimal duct obstruction (NLDO): Also known as dacryostenosis, this is a condition present at birth where the nasolacrimal duct is blocked, leading to epiphora (excessive tearing) and ocular discharge [9][14].
• Punctal stenosis: This refers to the narrowing or occlusion of the external opening of the lacrimal canaliculus, which can lead to symptoms of excessive tearing [11][12].
• Canalicular stenosis: Similar to punctal stenosis, this involves the narrowing or occlusion of the common canalicular duct, leading to reduced tear drainage and excessive tearing [12].
• Nasolacrimal duct obstruction (NLDO): This is a condition where the nasolacrimal duct is blocked, causing epiphora and ocular discharge. It can be acquired or congenital in nature [2][14].
• Wegener granulomatosis and sarcoidosis: These are conditions that can lead to obstruction of the nasal and lacrimal sac due to progressive inflammation [5].
• Punctal trauma: Trauma to the punctum can cause stenosis, leading to reduced tear drainage and excessive tearing [6].

It's essential to consider these differential diagnoses when evaluating patients with symptoms of stenosis of the lacrimal passage. A thorough understanding of the anatomy of the punctum and the lacrimal system is crucial for successful diagnosis and treatment.

References:

[1] Nasolacrimal duct obstruction (NLDO) or dacryostenosis is the most common disorder of the lacrimal system. [2] Approximately 6% to 20% of newborns patients present with some symptoms. [5] Wegener granulomatosis and sarcoidosis are conditions that lead to obstruction due to progressive inflammation within the nasal and lacrimal sac. [6] Punctal trauma can create stenosis. [9] Approximately 6% of newborns patients present with NLDO. [11] The incidence of punctal stenosis is variable, ranging from 8% to ... [12] The punctum may either become narrowed or occluded alone (punctal stenosis), in combination with canalicular stenosis (puncto-canalicular stenosis), in association with a distal lacrimal system obstruction (nasolacrimal duct obstruction). [14] Nasolacrimal duct obstruction (NLDO) or dacryostenosis is the most common disorder of the lacrimal system.