Nasolacrimal duct obstruction
| Nasolacrimal duct obstruction | |
|---|---|
 |
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| Tear system consists of lacrimal gland (a), punctums (b,e), canalicules (c,f), lacrimal sac (g,d). Tear is then drained through nasolacrimal duct (not shown in the image) into nasal cavity | |
| Classification and external resources | |
| Specialty | ophthalmology |
| ICD-10 | H04.5 |
| ICD-9-CM | 375.56 |
| MedlinePlus | 001016 |
| Congenital lacrimal duct obstruction | |
|---|---|
| Classification and external resources | |
| Specialty | ophthalmology |
| ICD-10 | Q10.5 |
| ICD-9-CM | 743.65 |
| MedlinePlus | 001016 |
| eMedicine | oph/465 oph/592 ent/452 |
| MeSH | D007767 |
Nasolacrimal duct obstruction (NLDO) is the obstruction of nasolacrimal duct and may be either congenital or acquired. Obstruction of the nasolacrimal duct leads to the excess overflow of tears called epiphora.
Excessive tearing is the most important complaint of patients with NLDO. Pain at the side of the nose suggests dacryocystitis.
Involutional stenosis is probably the most common cause of NLD obstruction in older persons. It affects women twice as frequently as men. Although the inciting event in this process is unknown, clinicopathologic study suggests that compression of the lumen of the NLD is caused by inflammatory infiltrates and edema. This may be the result of an unidentified infection or possibly an autoimmune disease.
Dacryoliths or cast formation, within the lacrimal sac can also produce obstruction of the NLD.
Sinus disease often occurs in conjunction with, and in other instances may contribute to the development of NLD obstruction. Patients should be asked about previous sinus surgery, as the NLD is sometimes damaged when the maxillary sinus ostium is being enlarged anteriorly.
Naso-orbital fractures may involve the NLD. Early treatment by fracture reduction with stenting of the entire lacrimal drainage system should be considered. However, such injuries are often not recognized or are initially neglected as more serious injuries are managed. In such cases, late treatment of persistent epiphora usually requires DCR.
Granulomatous disease, including sarcoidosis, granulomatosis with polyangiitis,and midline granuloma, may also lead to NLD obstruction.
As with similar cases of canalicular obstruction, dislodged punctal and canalicular plugs can migrate to and occlude the NLD.
Neoplasm should be considered in any patient presenting with NLD obstruction.In patients with an atypical presentation, including younger age and male gender,further workup is appropriate. Bloody punctal discharge or lacrimal sac distension above the medial canthal tendon is also highly suggestive of neoplasm.
Congenital nasolacrimal duct obstruction, or dacryostenosis, occurs when the lacrimal duct has failed to open at the time of birth, most often due to an imperforate membrane at the valve of Hasner. Around 6% of infants have CLDO, usually experiencing a persistent watery eye even when not crying. If a secondary infection occurs (Dacryocystitis), purulent (yellow / green) discharge may be present.
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