From the Guidelines
Nasolacrimal duct (NLD) obstruction is primarily caused by inflammation, trauma, or congenital abnormalities, leading to symptoms such as excessive tearing and eye infections, which can be addressed with a combination of conservative measures and surgical interventions, as seen in the context of Giant Fornix Syndrome 1. The causes of NLD obstruction can be multifaceted, including:
- Inflammation, which may be associated with conditions like conjunctivitis, as discussed in the conjunctivitis preferred practice pattern study 1
- Trauma to the eye or surrounding areas
- Congenital abnormalities, which may be present at birth Symptoms of NLD obstruction may include:
- Excessive tearing or epiphora
- Eye infections, such as conjunctivitis or dacryocystitis, which may require treatment with antibiotic regimens, as recommended in the study 1
- Redness and swelling of the eye or surrounding areas Treatment of NLD obstruction depends on the underlying cause and severity of the condition, but may involve:
- Conservative measures, such as warm compresses and digital massage of the lacrimal sac area
- Antibiotic eye drops, such as tobramycin 0.3% or moxifloxacin 0.5%, used 4 times daily for 7-10 days, if infection is present
- Nasolacrimal duct probing, especially in children under age 1
- Dacryocystorhinostomy (DCR) surgery, which may be necessary to create a new drainage pathway in adults with chronic obstruction, as mentioned in the context of addressing concomitant nasolacrimal duct obstruction and chronic dacryocystitis 1.
From the Research
Causes of Nasolacrimal Duct (NLD) Obstruction
- The etiology of acquired NLD obstruction is multifactorial and not fully understood 2
- Inflammation or fibrosis of the lacrimal sac are common histopathologic findings in patients with primary acquired NLD obstruction 3
- Other abnormalities, such as sarcoid granuloma, oncocytoma, and lymphoma, can also cause NLD obstruction 3
Symptoms of Nasolacrimal Duct (NLD) Obstruction
- Epiphora (overflow of tears) is the classic symptom of NLD obstruction, particularly among elderly people 4
- Mucous discharge is also a common symptom of NLD obstruction 5
- Dacryocystitis (infection of the nasolacrimal sac) can occur as a result of NLD obstruction 5, 2
- Lacrimal sac mucocele can also occur as a result of NLD obstruction 5
Diagnosis and Treatment of Nasolacrimal Duct (NLD) Obstruction
- Dacryocystorhinostomy (DCR) is the surgical correction of NLD obstruction, which aims to establish a new drainage pathway between the lacrimal sac and the nose 2, 4, 6
- Antimetabolites, such as mitomycin-C, can be used as an adjunct to DCR to improve functional and anatomic success 2
- Silicone stents can be used in some cases, but their use is not always necessary and may not confer a significant additional advantage in terms of postoperative success rates 4, 6