From the Research
Lacrimal stones, also known as dacryoliths, are calcified deposits that form in the lacrimal drainage system, typically in the lacrimal sac or nasolacrimal duct, and treatment usually involves surgical removal through a procedure called dacryocystorhinostomy (DCR) when the stones cause persistent symptoms like excessive tearing, recurrent infections, or pain. The most recent and highest quality study on this topic is from 2020, which discusses the utility and outcomes of endoscopic dacryocystorhinostomy (DCR) in patients with acute dacryocystitis and lacrimal abscess 1. According to this study, primary endoscopic DCR appears to be an effective modality in the management of acute dacryocystitis and lacrimal abscess, and results in a rapid resolution of inflammation while achieving comparable surgical success with a traditional approach.
Some key points to consider in the management of lacrimal stones include:
- The use of warm compresses applied to the inner corner of the eye for 5-10 minutes several times daily may provide temporary relief by promoting drainage
- Antibiotic eye drops such as moxifloxacin or tobramycin may be prescribed if infection is present, typically used 4 times daily for 7-10 days
- Lacrimal stones form due to stagnation of tears, chronic inflammation, or changes in tear composition that allow minerals to crystallize
- Risk factors include chronic conjunctivitis, previous eye surgery, or anatomical narrowing of the drainage system
- Without proper treatment, lacrimal stones can lead to recurrent eye infections and chronic tearing problems, so medical evaluation is recommended when symptoms persist.
It's also worth noting that a detailed patient history is crucial for diagnosis of lacrimal disorders, and precise inspection and palpation of the lacrimal and lid region may confirm lacrimal stenosis 2. Additionally, examinations of tear production, tear quality and the properties of the ocular surface are helpful, and the most important diagnostic tool is lacrimal duct probing and syringing.
In terms of treatment, therapy is guided by underlying pathologies, and treatment of congenital lacrimal stenosis follows a staged concept 2. Epiphora in adults without signs of dacryocystitis should be treated with dacryoendoscopy, and dacryoendoscopy is also a therapeutic option for chronic dacryocystitis, but dacryocystorhinostomy may also be required. Lacrimal trauma should be reconstructed rapidly after the incident by lacrimal intubation, and neoplasia of the lacrimal excretory system requires histological classification to enable multidisciplinary management.
Overall, the management of lacrimal stones requires a comprehensive approach that takes into account the underlying cause of the condition, as well as the patient's symptoms and medical history. Surgical removal of the stone through a procedure called dacryocystorhinostomy (DCR) is usually the most effective treatment option, and can provide significant relief from symptoms and improve quality of life 1.