eMedicine Specialties > Ophthalmology > Lacrimal System

Nasolacrimal Duct, Obstruction: Follow-up

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
Coauthor(s): Sandra R Worak, MD, Consulting Staff, Department of Orbit and Oculoplasty, Reconstructive and Lacrimal Surgery, East Avenue Medical Center; Alfonso U Bengzon, MD, MBA, Consulting Staff, Department of Ophthalmology, Makati Medical Center; Training Officer, Department of Ophthalmology Residency Training Program, Medical City General Hospital, Philippines
Contributor Information and Disclosures

Updated: Oct 22, 2008

Follow-up

Further Inpatient Care

  • Dacryocystorhinostomy may be performed as an outpatient procedure, especially if performed with a laser; there is less bleeding and faster recovery.

Further Outpatient Care

  • After the dacryocystorhinostomy, patients are given antibiotic eye drops and a nasal decongestant spray.
  • The silicone stent tube is removed after 3 months. In some situations (ie, Wegener granulomatosis), the stents may need to be retained indefinitely.

Inpatient & Outpatient Medications

  • Antibiotic/steroid eye drops, such as tobramycin/dexamethasone combination eye drops, are prescribed postoperatively for use 2-3 times per day for 2-3 weeks as prophylaxis to infection and to decrease postoperative inflammation.
  • Nasal decongestant sprays are prescribed postoperatively for use 2-3 times per day for 2-3 weeks.

Deterrence/Prevention

  • Early consultation when symptoms of tearing appear would be beneficial.
  • Appropriate antibiotics with lacrimal massage are the initial remedies for mild cases of obstruction.

Complications

  • Excessive bleeding (epistaxis)
  • Poor/delayed wound healing
  • Wound infection
  • Accidental removal of tube/stent by the patient
  • Restrictive strabismus

Prognosis

  • Both external dacryocystorhinostomy and endoscopic laser dacryocystorhinostomy have success rates higher than 90%; external dacryocystorhinostomy is slightly more successful.

Patient Education

  • Explain the following to the patient:
    • Normal lacrimal drainage process
    • Obstruction of lacrimal drainage passageway
    • Possible diagnostic tests that may be necessary to evaluate the condition and their possible results
    • Treatment protocols and options
    • If surgery is necessary, discuss the prognosis and possible intraoperative and postoperative complications.

Miscellaneous

Special Concerns

  • Diagnostic probing is only beneficial for congenital nasolacrimal duct obstruction.
  • Rule out neoplasms and systemic conditions.
  • Topical antiglaucoma medications may be associated with the development of lacrimal duct obstruction.
 


More on Nasolacrimal Duct, Obstruction

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Treatment & Medication: Nasolacrimal Duct, Obstruction
Follow-up: Nasolacrimal Duct, Obstruction
Multimedia: Nasolacrimal Duct, Obstruction
References
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References

  1. Linberg JV, McCormick SA. Primary acquired nasolacrimal duct obstruction. A clinicopathologic report and biopsy technique. Ophthalmology. Aug 1986;93(8):1055-63. [Medline].

  2. Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 1. Ophthal Plast Reconstr Surg. 1992;8(4):237-42. [Medline].

  3. Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 2. Ophthal Plast Reconstr Surg. 1992;8(4):243-9. [Medline].

  4. Bartley GB. Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 3. Ophthal Plast Reconstr Surg. 1993;9(1):11-26. [Medline].

  5. Groessl SA, Sires BS, Lemke BN. An anatomical basis for primary acquired nasolacrimal duct obstruction. Arch Ophthalmol. Jan 1997;115(1):71-4. [Medline].

  6. Karagülle T, Erden A, Erden I, et al. Nasolacrimal system: evaluation with gadolinium-enhanced MR dacryocystography with a three-dimensional fast spoiled gradient-recalled technique. Eur Radiol. Sep 2002;12(9):2343-8. [Medline].

  7. Anderson NG, Wojno TH, Grossniklaus HE. Clinicopathologic findings from lacrimal sac biopsy specimens obtained during dacryocystorhinostomy. Ophthal Plast Reconstr Surg. May 2003;19(3):173-6. [Medline].

  8. Ashenhurst ME, Hill VE, Keyhani K. Restrictive strabismus following Jones tube insertion: a case series of 8 patients. Can J Ophthalmol. Aug 2007;42(4):613-6. [Medline].

  9. Bajaj MS, Mahindrakar A, Pushker N. Dentigerous cyst in the maxillary sinus: a rare cause of nasolacrimal obstruction. Orbit. Dec 2003;22(4):289-92. [Medline].

  10. Becelli R, Renzi G, Mannino G, et al. Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures. J Craniofac Surg. Jan 2004;15(1):29-33. [Medline].

  11. Berry-Brincat A, Tomlins P, Hall A, et al. Primary extrasac orbital lymphoma presenting as nasolacrimal obstruction. Orbit. 2008;27(3):175-7. [Medline].

  12. Burns JA, Morgenstern KE, Cahill KV, et al. Nasolacrimal obstruction secondary to I(131) therapy. Ophthal Plast Reconstr Surg. Mar 2004;20(2):126-9. [Medline].

  13. Camara JG, Bengzon AU, Henson RD. The safety and efficacy of mitomycin C in endonasal endoscopic laser-assisted dacryocystorhinostomy. Ophthal Plast Reconstr Surg. Mar 2000;16(2):114-8. [Medline].

  14. Camara JG, Santiago MD. Success rate of endoscopic laser-assisted dacryocystorhinostomy. Ophthalmology. Mar 1999;106(3):441-2. [Medline].

  15. Camara JG, Santiago MD, Rodriguez RE, et al. The Micro-Reflux Test: a new test to evaluate nasolacrimal duct obstruction. Ophthalmology. Dec 1999;106(12):2319-21. [Medline].

  16. Couch SM, White WL. Endoscopically assisted balloon dacryoplasty treatment of incomplete nasolacrimal duct obstruction. Ophthalmology. Mar 2004;111(3):585-9. [Medline].

  17. de Bree R, Scheeren RA, Kummer A, et al. Nasolacrimal duct obstruction caused by an oncocytoma. Rhinology. Sep 2002;40(3):165-7. [Medline].

  18. Dolman PJ. Comparison of external dacryocystorhinostomy with nonlaser endonasal dacryocystorhinostomy. Ophthalmology. Jan 2003;110(1):78-84. [Medline].

  19. Erkan AN, Yilmazer C, Altan-Yaycioglu R. Otologic T-tube in endonasal dacryocystorhinostomy: a new approach. Acta Otolaryngol. Dec 2007;127(12):1316-20. [Medline].

  20. Esmaeli B, Hidaji L, Adinin RB, et al. Blockage of the lacrimal drainage apparatus as a side effect of docetaxel therapy. Cancer. Aug 1 2003;98(3):504-7. [Medline].

  21. Gokcek A, Argin MA, Altintas AK. Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings. Eur J Ophthalmol. Sep-Oct 2005;15(5):523-9. [Medline].

  22. Goldberg RA, Samimi DB, Tsirbas A, et al. The hydrogel lacrimal stent for dacryocystorhinostomy: preliminary experience. Ophthal Plast Reconstr Surg. Mar-Apr 2008;24(2):85-9. [Medline].

  23. Golub JS, Parikh SL, Budnick SD, et al. Inverted papilloma of the nasolacrimal system invading the orbit. Ophthal Plast Reconstr Surg. Mar-Apr 2007;23(2):151-3. [Medline].

  24. Kashkonli MB, Rezaee R, Nilforonshan N, et al. Topical antiglaucoma medications and lacrimal drainage system obstruction. Ophthal Plast Reconstr Surg. May-Jun 2008;24(3):175-6.

  25. Katowitz JA, Low JE. Lacrimal surgery. In: Duane's Ophthalmology. Vol 5. [book on CD-ROM]; 1998:Chapter 79.

  26. Kim KR, Song HY, Shin JH, et al. Efficacy of mitomycin C irrigation after removal of an occluded nasolacrimal stent. J Vasc Interv Radiol. Apr 2007;18(4):519-25. [Medline].

  27. Kim KR, Song HY, Shin JH, et al. Eficacy of Mitomycin-C irrigation after balloon dacryoplasty. J Vasc Interv Radiol. Jun 2007;18(6):757-62.

  28. Kloos RT, Duvuuri V, Jhiang SM, et al. Nasolacrimal drainage system obstruction from radioactive iodine therapy for thyroid carcinoma. J Clin Endocrinol Metab. Dec 2002;87(12):5817-20. [Medline].

  29. Lueder GT. Balloon catheter dilation for treatment of older children with nasolacrimal duct obstruction. Arch Ophthalmol. Dec 2002;120(12):1685-8. [Medline].

  30. Lueder GT. Endoscopic treatment of intranasal abnormalities associated with nasolacrimal duct obstruction. J AAPOS. Apr 2004;8(2):128-32. [Medline].

  31. Mauffray RO, Hassan AS, Elner VM. Double silicone intubation as treatment for persistent congenital nasolacrimal duct obstruction. Ophthal Plast Reconstr Surg. Jan 2004;20(1):44-9. [Medline].

  32. Mirza S, Al-Barmani A, Douglas SA, et al. A retrospective comparison of endonasal KTP laser dacryocystorhinostomy versus external dacryocystorhinostomy. Clin Otolaryngol Allied Sci. Oct 2002;27(5):347-51. [Medline].

  33. Nemet AY, Wilcsek G, Francis IC. Endoscopic dacryocystorhinostomy with adjunctive mitomycin C for canalicular obstruction. Orbit. Jun 2007;26(2):97-100. [Medline].

  34. Nguyen LK, Linberg JV. Evaluation of the lacrimal system. In: Surgery of the eyelid, orbit, and lacrimal system. American Academy of Ophthalmology. 1995;3:254-69.

  35. Oghan F, Ozcura F. A novel stenting technique in endoscopic dacryocystorhinostomy. Eur Arch Otorhinolaryngol. Aug 2008;265(8):911-5. [Medline].

  36. Oztürk S, Konuk O, Ilgit ET, et al. Outcome of patients with nasolacrimal polyurethane stent implantation: do they keep tearing?. Ophthal Plast Reconstr Surg. Mar 2004;20(2):130-5. [Medline].

  37. Paúl L, Pinto I, Vicente JM. Treatment of complete obstruction of the nasolacrimal system by temporary placement of nasolacrimal polyurethane stents: preliminary results. Clin Radiol. Nov 2003;58(11):876-82. [Medline].

  38. Seider N, Miller B, Beiran I. Topical glaucoma therapy as a risk factor for nasolacrimal duct obstruction. Am J Ophthalmol. Jan 2008;145(1):120-123. [Medline].

  39. Shepler TR, Sherman SI, Faustina MM, et al. Nasolacrimal duct obstruction associated with radioactive iodine therapy for thyroid carcinoma. Ophthal Plast Reconstr Surg. Nov 2003;19(6):479-81. [Medline].

  40. Tabatabaie SZ, Heirati A, Rajabi MT, et al. Silicone intubation with intraoperative mitomycin C for nasolacrimal duct obstruction in adults: a prospective, randomized, double-masked study. Ophthal Plast Reconstr Surg. Nov-Dec 2007;23(6):455-8. [Medline].

  41. Tao S, Meyer DR, Simon JW, et al. Success of balloon catheter dilatation as a primary or secondary procedure for congenital nasolacrimal duct obstruction. Ophthalmology. Nov 2002;109(11):2108-11. [Medline].

  42. Tsirbas A, Davis G, Wormald PJ. Mechanical endonasal dacryocystorhinostomy versus external dacryocystorhinostomy. Ophthal Plast Reconstr Surg. Jan 2004;20(1):50-6. [Medline].

  43. Tsirbas A, Wormald PJ. Endonasal dacryocystorhinostomy with mucosal flaps. Am J Ophthalmol. Jan 2003;135(1):76-83. [Medline].

  44. Udhay P, Noronha OV, Mohan RE. Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses. Indian J Ophthalmol. Jan-Feb 2008;56(1):31-7. [Medline].

  45. Wobig JL, Dailey RA. Surgery of the Lacrimal System. In: Surgery of the eyelid, orbit, and lacrimal system. American Academy of Ophthalmology. 1995;3:270-87.

  46. Woog JJ, Kennedy RH, Custer PL, et al. Endonasal dacryocystorhinostomy: a report by the American Academy of Ophthalmology. Ophthalmology. Dec 2001;108(12):2369-77. [Medline].

  47. Yildirim C, Yaylali V, Esme A, et al. Long-term results of adjunctive use of mitomycin C in external dacryocystorhinostomy. Int Ophthalmol. Feb 2007;27(1):31-5. [Medline].

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Further Reading

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Keywords

nasolacrimal duct obstruction, nasolacrimal drainage obstruction, NLDO, tear-duct obstruction, tear duct obstruction, tear ducts, epiphora, tear drainage, lacrimal drainage system, tearing, tear production

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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 Medical Association
Disclosure: Nothing to disclose.

Alfonso U Bengzon, MD, MBA, Consulting Staff, Department of Ophthalmology, Makati Medical Center; Training Officer, Department of Ophthalmology Residency Training Program, Medical City General Hospital, Philippines
Alfonso U Bengzon, MD, MBA is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

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 Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

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 Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching; Ortho-Neutrogenia Consulting fee Consulting

CME Editor

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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