stenosis of lacrimal sac

Stenosis of the Lacrimal Sac

Stenosis of the lacrimal sac refers to a narrowing or obstruction of the lacrimal sac, which is a small, pear-shaped structure located under the eyebrow bone. The lacrimal sac is responsible for collecting and storing tear fluid from the eye.

• Causes: Stenosis of the lacrimal sac can be caused by various factors, including congenital abnormalities, trauma, or inflammation.
• Symptoms: Symptoms of stenosis of the lacrimal sac may include:
  • Excessive tearing
  • Redness and swelling around the eye
  • Eye pain or discomfort
  • Difficulty draining tears from the eye
• Types: Stenosis of the lacrimal sac can be classified into two main types: congenital stenosis, which is present at birth, and acquired stenosis, which develops later in life.
• Treatment: Treatment for stenosis of the lacrimal sac depends on the underlying cause and severity of the condition. In some cases, simple measures such as massaging the lacrimal sac or using warm compresses may help to relieve symptoms. However, more severe cases may require surgical intervention, such as probing or silicone intubation.

References

• [6] Congenital stenosis of the nasolacrimal duct is a common condition in newborns, with an incidence rate of 6% (Source: #6)
• [10] Nasolacrimal duct obstruction (NLDO) or dacryostenosis is the most common disorder of the lacrimal system, presenting with symptoms such as excessive tearing and ocular discharge. (Source: #10)
• [11] Dacryostenosis is obstruction or stenosis of the nasolacrimal duct, causing excess tearing. Manual compression of the lacrimal sac may relieve the obstruction. (Source: #11)

Common Signs and Symptoms of Lacrimal Sac Stenosis

Lacrimal sac stenosis, also known as nasolacrimal duct obstruction (NLDO), is a condition where the tear drainage system becomes blocked. This can lead to various signs and symptoms, which are essential to recognize for proper diagnosis and treatment.

• Watery eyes: Excessive tearing is one of the most common symptoms of lacrimal sac stenosis [12][13].
• Eyelids may be red and swollen: The eyelids can become inflamed and swollen due to the accumulation of tears and mucus [3][7][8].
• Tears pooling in the corner of the eye: Tears may accumulate in the corner of the eye, causing a visible pool of liquid [1][2].
• Mucus or yellowish discharge: A thick, yellowish or greenish discharge can be seen on the eyelids or in the eyelashes [3][11].
• Reddening of the skin: The skin around the eye may become red and inflamed due to the blockage and subsequent infection [4][10].

Additional Symptoms

In some cases, lacrimal sac stenosis can lead to more severe symptoms, including:

• Painful swelling near the inside corner of the eye: Swelling and pain in this area can be a sign of an underlying infection or abscess [5].
• Blurred vision: In rare cases, lacrimal sac stenosis can cause blurred vision due to the accumulation of tears and mucus on the surface of the eye [11].

Important Notes

It's essential to seek medical attention if you experience any of these symptoms, as untreated lacrimal sac stenosis can lead to more severe complications, such as infection (dacryocystitis) or damage to the surrounding tissues.

Diagnostic Tests for Stenosis of Lacrimal Sac

Stenosis of the lacrimal sac, also known as dacryostenosis, is a condition where the nasolacrimal duct is obstructed or narrowed, causing excess tearing. The following diagnostic tests can help determine the presence and extent of stenosis:

• Tear drainage test (Dye disappearance test): This test measures how quickly tears drain from the eye. A drop of fluorescein-stained saline is placed in the inferior cul-de-sac of each eye, and the time it takes for the dye to disappear is measured [8][15]. This test can help diagnose stenosis and determine if tears are draining at a proper rate.
• Lacrimal duct probing and syringing: This procedure involves inserting a probe into the lacrimal duct to check for blockages or narrowing. If a blockage is found, a syringe may be used to inject saline solution to clear the obstruction [2].
• Dacryoscintigraphy: This imaging test uses a radioactive dye to visualize the tear drainage system and detect any obstructions or stenosis in the lacrimal duct [3].
• Eye imaging tests (CT and/or MRI): These tests may be necessary to determine the diagnosis, especially if other conditions are suspected. However, they are not typically used as primary diagnostic tools for stenosis of the lacrimal sac.
• Schirmer's test: This test measures tear production by placing a small strip of filter paper in the lower eyelid to measure the amount of tears produced over a set period [10].

These tests can help diagnose and assess the severity of stenosis of the lacrimal sac, allowing for proper treatment planning.

The differential diagnosis for stenosis of the lacrimal sac is broad and includes various conditions that can cause similar symptoms. Here are some possible causes:

• Conjunctivitis: Inflammation of the conjunctiva, which can cause redness, swelling, and discharge in the eye.
• Corneal abrasion: A scratch or injury to the cornea, which can cause pain, redness, and sensitivity to light.
• Uveitis: Inflammation of the uvea, which is the middle layer of the eye.
• Hemangiomas: Benign tumors made up of blood vessels that can occur in the eyelid or orbit.
• Dermoids: Congenital cysts that contain skin and other tissues that can occur in the eyelid or orbit.
• Nasal gliomas: Rare congenital tumors that can occur in the nasal cavity and cause symptoms similar to lacrimal sac stenosis.

These conditions can be ruled out through a combination of clinical evaluation, imaging studies (such as CT scans), and other diagnostic tests. The diagnosis of lacrimal sac stenosis is typically made based on a combination of:

• Clinical history: A thorough review of the patient's symptoms and medical history.
• Physical examination: A detailed examination of the eye and surrounding tissues to look for signs of inflammation, scarring, or other abnormalities.
• Imaging studies: CT scans or other imaging tests may be used to visualize the lacrimal sac and surrounding structures.

It's worth noting that the differential diagnosis for stenosis of the lacrimal sac can vary depending on the age of the patient and the presence of any underlying medical conditions. [Source: 11, 12]

References: * NLDO is by far the most common cause of epiphora and periocular discharge in infants. * The presence of enlarged tear lakes and periocular discharge helps confirm the diagnosis ... * Dacryostenosis is obstruction or stenosis of the nasolacrimal duct, causing excess tearing.