Lacrimal System - Overview

Overview, Signs and Symptoms of an Obstruction

• The lacrimal gland produces tears which enter into the "duct"
  that drain the tears from the eye into the nose. The most common symptoms are
  • (1) excess tearing (tears may run down the face) and
  • (2) mucous discharge
• If one has a plugged up "tear duct," not only will tears spill over the eyelids and
  run down the face, but the stagnant tears within the system can become infected.
• This may lead to recurrent red eyes and infections.
• The excessive tearing can also produce secondary skin changes on the lower eyelids.

Congenital Nasolacrimal Duct Obstruction

Nasolacrimal Duct Obstruction (NLDO) is very common in infants.

• Children are frequently born with an obstruction within the "tear duct." In fact, 6% of all children are born before their tear ducts are open.
• The stagnant tears within the "tear duct" often become infected causing pus (heavy matter) to collect between the eyelids.
• Antibiotics may help some of the symptoms, BUT this is not cure for the blockage
• Such obstructions may resolve spontaneously within the first few months of life. In fact, 95% of these children will show resolution before their first birthday. If it does not resolve surgery may be necessary.

Blockage presents in one of four ways:

	simple obstruction
	congenital fistula (as seen to the left)
	acute dacryocystitis
	congenital dacryocele or mucocele

The very end of this duct is the most common place for blockage to occur. This site is called the valve of Hasner at the distal nasolacrimal duct and may represent failure of canalization of the epithelial cells that form the duct.

Medical Treatment of Congenital Obstructions

• Many of these do open on their own given time.
• Massaging from the tear sac in the may help create a pressure wave that can open the blockage.

Acquired (ADULT-ONSET) Nasolacrimal Duct Obstruction

• Causes of Acquired nasolacrimal duct obstruction
  • most commonly involutional
  • affects females more than males
  • trauma
  • sinus disease
  • nasal polyps
  • sarcoid
  • Wegener's and other granulomatous diseases
  • tumor
  • infection
  
  

  The photo and CT on the left represents a nasolacrimal duct tumor which can result in a nasolacrimal duct obstruction. Once the tumor was removed, silicone intubation performed, the patient's symptoms of tearing resolved

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