acquired tear duct stenosis

Acquired Tear Duct Stenosis: A Condition That Affects the Lacrimal Outflow System

Acquired nasolacrimal duct obstruction, also known as acquired tear duct stenosis, is a condition that affects the lacrimal outflow system. This condition is characterized by a blockage or narrowing of the nasolacrimal duct, which is the tube that collects tears from the inner corner of the eye and drains them into the nose.

Causes and Symptoms

The most common cause of acquired tear duct stenosis is local nonspecific inflammation of the lacrimal sac [4][9]. This can lead to a blockage or narrowing of the nasolacrimal duct, causing excess tearing (epiphora) and periocular crusting and discharge [10].

Prevalence

Acquired tear duct stenosis is a relatively common condition, with studies suggesting that it affects up to 6% of newborns [3]. However, it can also occur in adults due to various factors such as trauma, infection, or inflammation.

Treatment Options

The treatment options for acquired tear duct stenosis depend on the underlying cause and severity of the condition. In some cases, simple measures such as warm compresses or antibiotics may be sufficient to resolve the issue. However, more severe cases may require surgical intervention to restore normal drainage of tears from the eye.

References:

• [1] Sweeney AR. Secondary acquired nasolacrimal duct obstruction (SANDO).
• [3] Congenital lacrimal duct obstruction.
• [4] Makselis A. Acquired nasolacrimal duct obstruction. 2022.
• [9] Makselis A. Acquired nasolacrimal duct obstruction. 2022.
• [10] Lueder GT. Lacrimal drainage system obstruction.

Common Signs and Symptoms of Acquired Tear Duct Stenosis

Acquired tear duct stenosis, also known as nasolacrimal duct obstruction (NLDO), is a condition where the tear duct becomes blocked or narrowed. This can cause a range of symptoms, including:

• Increased tearing: Excessive tears may overflow onto the face or cheek, causing epiphora [6][8].
• Discharge and crusting: A gooey or crusty buildup on the eyelids or in the eyelashes can occur due to the blocked tear duct [10].
• Redness and swelling: Rubbing the eye or face around the blocked duct can cause redness and swelling [10].
• Blurred vision: In some cases, blurred vision may be experienced due to the blockage [10].

These symptoms can vary in severity and may resemble other conditions or medical problems. It's essential to consult a healthcare provider for an accurate diagnosis.

Additional Information

Acquired tear duct stenosis is often caused by infections, inflammation, or injuries that affect the nasolacrimal duct. In some cases, it may be related to underlying disorders or conditions [6][12].

Treatment options depend on the cause and severity of the blockage, as well as the age of the affected individual. In many cases, surgery may be necessary to correct the issue [15].

Acquired tear duct stenosis, also known as secondary acquired nasolacrimal duct obstruction (SANDO), can be diagnosed through various tests. Here are some diagnostic procedures that may be used to confirm the condition:

• Dye disappearance test: This is a simple test where a drop of fluorescein dye is placed on the surface of each eye. The dye is then observed for 5 minutes, and if most of it remains on the surface after this time, it may indicate a blocked tear duct [12].
• Tear drainage test: Similar to the dye disappearance test, this measures how quickly tears are draining from the eyes. A drop of special dye is placed on the surface of each eye, and the rate at which it drains is observed [13].
• Irrigation and probing: This procedure involves flushing fluid through the tear duct opening to check for blockage. If the fluid does not flow into the nose or throat, it may indicate a blocked tear duct [9].
• Dacryocystography: This test involves injecting dye into the tear duct and tracing its movement with X-ray and/or CT scan. It can help diagnose nasolacrimal duct obstruction [2].
• Dacryoscintigraphy: This is another test that uses a radiotracer eye drop to record the movement of tears through the lacrimal drainage system over time. It may be used to classify types of obstruction and predict postoperative results [7].

These diagnostic tests can help confirm the presence of acquired tear duct stenosis, allowing for proper treatment and management of the condition.

References:

[1] Not provided in context [2] Not provided in context [7] Jun 16, 2023 — Functional lacrimal duct obstruction is easily diagnosed with dacryoscintigraphy. It may be classified by types of obstruction to predict postoperative results. [9] One test that your doctor may perform involves flushing fluid in your tear duct opening. If the fluid does not flow into your nose or throat, you will be. [12] Tests used to diagnose a blocked tear duct include: Tear drainage test. This test measures how quickly your tears are draining. One drop of a special dye is placed on the surface of each eye. You may have a blocked tear duct if after five minutes most of the dye is still on the surface of your eye. [13] Clinical diagnosis Generally clear discharge without underlying conjunctivitis and lacrimal flow obstruction; Dye disappearance test. Not always necessary, but used to test if tears are draining at proper rate (particularly for intermittent symptoms) Place a drop of fluorescein-stained saline in the inferior cul-de-sac of each of eye

Based on the provided context, it appears that drug treatment for acquired tear duct stenosis may involve antibiotics.

• Topical antibiotics with lacrimal massage may be adequate for early infections [8].
• Systemic antibiotics may be necessary for more chronic or severe infections [8].

It's also mentioned that if a tumor is causing the blocked tear duct, treatment will focus on the cause of the tumor, and surgery may be performed to remove the tumor, or other treatments may be recommended to shrink it [12]. However, this seems to be more related to congenital cases rather than acquired ones.

In general, the most common approach for treating a blocked tear duct is not necessarily drug-based but rather mechanical, such as "milking" or massaging the nasolacrimal duct two to three times a day [3][14].

It's worth noting that in some cases, especially after a facial injury, the drainage system may start working again on its own a few months after the injury, and no additional treatment is necessary [15].

Differential Diagnosis of Acquired Tear Duct Stenosis

Acquired tear duct stenosis, also known as nasolacrimal duct obstruction (NLDO), is a condition where the tear drainage system becomes blocked. The differential diagnosis for this condition includes various etiologies that can cause the blockage.

• Trauma: Physical trauma to the eye or face can cause acquired NLDO by damaging the lacrimal sac or nasolacrimal duct.
• Viral conjunctivitis: Certain viral infections, such as adenovirus, can cause inflammation and scarring in the tear drainage system, leading to blockage.
• Acute dacryocystitis: Inflammation of the lacrimal sac can cause a blockage in the nasolacrimal duct.
• Topical antiviral medications: Certain eye drops or ointments used to treat viral infections can cause acquired NLDO as a side effect.

Other conditions that may be considered in the differential diagnosis for acquired tear duct stenosis include:

• Glaucoma: Increased pressure in the eye can cause inflammation and scarring in the tear drainage system.
• Congenital anomalies of the upper lacrimal drainage system: Conditions such as punctal or canalicular atresia can increase the risk of developing acquired NLDO.

Prevalence and Presentation

Acquired NLDO is a relatively rare condition, but it can cause significant symptoms, including excessive tearing (epiphora) and ocular discharge. The prevalence of acquired NLDO varies depending on the population being studied, but it is estimated to account for approximately 31.8% of all chronic epiphora cases.

References

• [1] Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 1.
• [2] Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology. 1986;93(5):643-648.

Note: The references provided are based on the search results and may not be an exhaustive list of all relevant studies on this topic.