Obstruction Nasolacrimal Duct Clinical Presentation

  • Author: Jorge G Camara, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 9, 2012
 

History

  • Symptoms
    • Epiphora, mucoid, or purulent discharge
    • Recurrent dacryocystitis, recurrent conjunctivitis or ocular pemphigus
    • Painful, swelling medial canthus
    • Bloody tears
    • Epistaxis (nasal, sinus, or lacrimal sac tumor)
  • Past ocular history
    • Previous eye surgery (dacryocystorhinostomy)
    • Lid surgery
    • Glaucoma (antiglaucoma medications)[6, 7]
    • Use of other topical medications
  • Past medical history
    • Lymphoma,[8] Wegener granulomatosis
    • Sarcoidosis
    • Ocular cicatricial pemphigoid
    • Kawasaki disease
    • Scleroderma
    • Sinus histiocytosis
    • Previous radiation treatment to medial canthal area systemic chemotherapy with 5-FU
    • Parasitic infection
    • Facial trauma
    • Previous nasal or sinus surgery
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Physical

  • Gross observations include the following:
    • Overflow of tears
    • Fluctuant tender mass over lacrimal sac area or medial canthal area
    • Mucoid or purulent eye discharge - Significantly distended sac may not regurgitate with pressure due to the functional valve of Rosenmüller
    • Regurgitation test - Mucoid reflux with lacrimal massage indicative of lower system obstruction
  • Slit lamp findings include the following:
    • Tear meniscus height enhanced by fluorescein - Meniscus height greater than 2 mm
    • Punctal stenosis
    • Canaliculitis - Canalicular fullness and creamy pus when canaliculus is pressed
    • Expression of concretions from punctum
    • Pouting punctum with purulent material at opening
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Causes

  • PANDO - Idiopathic inflammation and fibrosis of nasolacrimal duct, resulting in partial stenosis or complete obliteration of duct lumen
  • SALDO
    • Infectious
      • Bacteria
      • Viruses
      • Fungi
      • Parasites
    • Inflammatory
      • Exogenous
      • Endogenous
    • Neoplastic
      • Primary
      • Secondary
      • Metastatic
    • Traumatic
      • Idiopathic
      • Nonidiopathic
    • Mechanical
      • Intraluminal foreign body
      • External compression/occlusion
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Jorge G Camara, MD  Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Sandra R Worak, MD  Consulting Staff, Department of Orbit and Oculoplasty, Reconstructive and Lacrimal Surgery, East Avenue Medical Center

Sandra R Worak, MD is a member of the following medical societies: Philippine Academy of Ophthalmology and Philippine Medical Association

Disclosure: Nothing to disclose.

Alfonso U Bengzon, MD, MBA  Consulting Staff, Department of Ophthalmology; Section Head, Section of Oculoplastic and Orbit Surgery, Department of Ophthalmology, The Medical City General Hospital, Philippines; Consultant Head, The Medical City Diagnostic and Laser Eye Center

Alfonso U Bengzon, MD, MBA is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD  Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Dacryocystitis of the left nasolacrimal system.
Dacryocystogram. A patent nasolacrimal system on the right side of a patient and a blocked system on the contralateral side at the level of the nasolacrimal duct.
Endoscopic laser-assisted dacryocystorhinostomy.
 
 
 
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