Obstruction of the nasolacrimal duct is known as dacryostenosis, and two major subtypes exist - congenital and acquired [1] [2] [3]. In newborns, the condition stems from both embryological (incomplete canalization) or mechanical (displacement of the cranial structures situated in the area where the nasolacrimal apparatus is located) events during embryonal life, childbirth or in the postpartum period [1] [3]. The majority of acquired cases, on the other hand, are seen in adults over 50 years of age, with many diagnoses being idiopathic, but tumors, surgical procedures, trauma, and sarcoidosis have been reported as possible causes [2]. The most prominent symptom of dacryostenosis is epiphora (increased watering of the eye) that may be persistent and followed by mucopurulent discharge [1] [4]. Visual blurring, as well as driving and reading difficulties, are reported in adults [5]. Despite the fact that 20-70% of neonates present with epiphora that strongly suggests dacryostenosis, a complete resolution is seen in up to 96% of cases by the first year of life, but if the problem persists, or is undiagnosed, several complications can arise [1]. Secondary infections (conjunctivitis, dacryocystitis or orbital cellulitis), unequal refractive power (anisometropia) as the affected eye may develop refractive error, or the formation of a dacryocystocele, which will obstruct the nasal passage of air and cause respiratory difficulties [1] [2] [3] [6].

• Inflammation

  CONCLUSIONS: Descending inflammation from the eye or ascending inflammation from the nose initiates swelling of the mucous membrane, remodeling of the helical arrangement of connective tissue fibers, malfunctions in the subepithelial cavernous body with [ncbi.nlm.nih.gov]

  The following pathogenic concept of primary acquired dacryostenosis has been postulated: descending inflammation from the eye or ascending inflammation from the region of the nose (perhaps by way of inflammation of "ectopical" nasal epithelial cells in [rrnursingschool.biz]

  Chronic inflammation is more commonly seen in adults than in children. Such inflammation can be caused by other underlying diseases such as an autoimmune disease. Fibrosis Fibrosis formation is usually a result of chronic inflammation or infection. [ehealthwall.com]

• Swelling

  […] weeks of life; up to 1 month - continuous or intermittent tearing; looks wet with crusting - clear conjunctiva; no redness - tearing or moist appearing eye - expression of thin, mucopurulent exudate from lacrimal sac - conjunctiva clear - no eyelid swelling [quizlet.com]

  CONCLUSIONS: Descending inflammation from the eye or ascending inflammation from the nose initiates swelling of the mucous membrane, remodeling of the helical arrangement of connective tissue fibers, malfunctions in the subepithelial cavernous body with [ncbi.nlm.nih.gov]

  Both the trapped tears and infection will cause swelling and irritation. Blocked Tear Duct Copyright © Nucleus Medical Media, Inc. Risk Factors Dacryocystitis is most common in infants with blocked tear ducts. [azkrmc.com]

  Heat helps decrease swelling. When should I contact my child's healthcare provider? Your child has a fever. Your child's eye is red, swollen, or draining yellow fluid. Your child seems weak and is irritable. Your child has a nosebleed. [drugs.com]

• Surgical Procedure

  Addressing everything from genetic considerations, embryology and anatomy, anesthesia, dermatologic considerations, benign and malignant tumors, fetal wound healing, establishing propoer diagnosis, timing for surgical interventions and surgical procedures [books.google.de]

  The majority of acquired cases, on the other hand, are seen in adults over 50 years of age, with many diagnoses being idiopathic, but tumors, surgical procedures, trauma, and sarcoidosis have been reported as possible causes. [symptoma.com]

  If canalicular stenosis is severe and bothersome, a surgical procedure (conjunctivo-dacryocystorhinostomy or C-DCR) that places a tube made of low thermal-expansion borosilicate glass (Jones tube) leading from the caruncle into the nasal cavity can be [merckmanuals.com]

  If canalicular stenosis is severe and bothersome, a surgical procedure (conjunctivo-dacryocystorhinostomy or C-DCR) that places a tube made of low thermal-expansion borosilicate glass (Jones tube) leading from the caruncle (the small, pink, nodule at [msdmanuals.com]

• Weakness

  Your child seems weak and is irritable. Your child has a nosebleed. You have questions or concerns about your child's condition or care. When should I seek immediate care or call 911? Your child has severe pain. Your child's eye starts to bleed. [drugs.com]

  […] growth that is large or rapidly growing If the obstruction causes severe and persistent symptoms If the obstruction causes changes in the contour, shape and position of the eyes If other systemic symptoms are present, such as fever, pain, fatigue, and weakness [ehealthwall.com]

  Symptoms include weak facial muscles, difficulty closing the eye, infrequent blinking, earache, acute hearing, facial drooping, ectropion, tearing, eye dryness, blurred vision and a burning feeling in the eye. [allaboutvision.com]

  It might possibly be either functional due to a displaced punctum, eyelid laxity, weak orbicularis, or facial nerve palsy or an anatomical obstruction might possibly block the drainage of tears. [eyeplastics.com]

  […] been considered at high risk for DCR failure given his past medical history, and it is possible that his early loss of lacrimal stenting contributed to the failure.(3) The present study is limited by the relatively short follow-up period and by other weaknesses [djo.harvard.edu]

• Asymptomatic

  The course of sarcoidosis ranges from asymptomatic to severe. It could affect people of all ages. The disease affects predominantly the lungs and lymph nodes, skin, abdominal organs or eyes. Sarcoidosis of lacrimal sac is very uncommon. [ncbi.nlm.nih.gov]

  More than 90% of these cases clear and become asymptomatic with conservative management. [emedicine.medscape.com]

• Overeating

  Presentation Epiphora (watering eyes) which develops within six weeks of birth, sticky eyes, recurrent conjunctivitis, crusting of the eyelids, ± boggy swelling over the inner canthal region from which it may be possible to express pus. [patient.info]

  A little over a year ago, Dr. Rupp replaced my right knee! It took approximately 6 months to feel good, then another 6 months to feel great... Now it is as good as new. No pain, stiffness or complications. I can ... [tahoeorthopedics.com]

  The distinguished contributors have combined their surgical knowledge and experience with over 1,100 color photographs and custom illustrations to present comprehensive and readily usable information on the identification and treatment of a wide range [books.google.de]

  […] obstruction and recurrent purulent discharge beyond 6-12 months may require surgery - also refer if severe for systemic antibiotics - ophthalmia neonatorum - conjunctivitis - dacryoscystitis * infection of obstructed duct i.e. fever, erythema, swelling over [quizlet.com]

• Lacrimation

  […] dacryostenosis [ dak″re-o-stĕ-no´sis ] stricture or narrowing of a lacrimal duct. dac·ry·o·ste·no·sis ( dak'rē-ō-ste-nō'sis ), Stricture of the lacrimal duct. [medical-dictionary.thefreedictionary.com]

  H04.561 Stenosis of right lacrimal punctum H04.562 Stenosis of left lacrimal punctum H04.563 Stenosis of bilateral lacrimal punctum H04.569 Stenosis of unspecified lacrimal punctum H04.57 Stenosis of lacrimal sac H04.571 Stenosis of right lacrimal sac [icd10data.com]

  The most important diagnostic examinations are the slitlamp examination of the eyelids, of the lacrimal puncta and of the anterior segment of the globe, the 'lacrimal punctum excursion test', the diagnostic rinse of the lacrimal passages, the dacryocystography [ncbi.nlm.nih.gov]

  lacrimal canaliculi, Obstruction of lacrimal ducts (disorder), Blocked lacrimal canaliculus, Blocked lacrimal canaliculus (finding), lacrimal passages; obstruction, lacrimal passages; occlusion, obstruction; lacrimal passages, occlusion; lacrimal passages [fpnotebook.com]

• Excessive Tearing

  Symptoms include excessive tearing. Reflux of saline or fluorescein dye when flushing the lacrimal drainage system confirms the diagnosis. [merckmanuals.com]

  Sudden swelling and redness in the area of the tear sac should be reported to your baby's doctor right away. Parents should remember that not all excessive tearing in infants and children is caused by tear duct blockage. [drhull.com]

  If abnormal tear production is ruled out, then obstructions in tear drainage is the most likely cause of the excessive tearing. [encyclopedia.com]

• Fracture

  Seite 102 - Smith B: Naso-orbital fractures and traumatic deformities of the medial canthus. Plast Reconstruct Surg 38:147-162, 1966. ‎ Bibliografische Informationen [books.google.de]

  Trauma [ edit ] Naso-orbital fractures may involve the NLD. Early treatment by fracture reduction with stenting of the entire lacrimal drainage system should be considered. [en.wikipedia.org]

  Other causes include past nasal or facial bone fractures and sinus surgery, which disrupt the nasolacrimal duct; inflammatory diseases (eg, sarcoidosis, granulomatosis with polyangiitis [formerly Wegener granulomatosis]); tumor (eg, maxillary and ethmoid [merckmanuals.com]

• Suggestibility

  Bloody punctual discharge or lacrimal sac distension above the medial canthal tendon is also highly suggestive of neoplasm. [en.wikipedia.org]

  Until the child is about 1 year old, doctors often suggest that parents gently massage the tear sac 4 or 5 times per day to help relieve the blockage. [merckmanuals.com]

  Recent findings have indicated that "functional obstruction" of the lacrimal passage occurs in many more patients than suggested previously (Table 2.1) [25]. [rrnursingschool.biz]

  However, our findings do suggest that at least 10% of children from the region referred with congenital dacryostenosis have amblyopia and that non-refractive causes are common. [healio.com]

• Fussiness

  This treatment did not alleviate her symptoms, and she subsequently developed erythema, swelling, fussiness, and poor feeding. [pedsinreview.aappublications.org]

• Irritability

  Trichiasis — A disease of the eye, in which the eyelashes, being turned in upon the eyeball, produce constant irritation by the motion of the lids. [encyclopedia.com]

  Complications of tear duct blockage are rare, but can include such things as irritation of the skin around the eye from all the tear overflow, and more serious infections of the tear sac. [drhull.com]

  Your child seems weak and is irritable. Your child has a nosebleed. You have questions or concerns about your child's condition or care. When should I seek immediate care or call 911? Your child has severe pain. Your child's eye starts to bleed. [drugs.com]

  […] may require surgery - also refer if severe for systemic antibiotics - ophthalmia neonatorum - conjunctivitis - dacryoscystitis * infection of obstructed duct i.e. fever, erythema, swelling over duct - glaucoma - intraoccular inflammation - external irritation [quizlet.com]

  The tears from the eyes cannot drain through the normal pathway and this leads to watery and irritated eye Blocked Tear Duct is common in newborn children, though adults may also be affected. [dovemed.com]

A detailed physical examination and a properly obtained patient history obtained from the parents in the setting of congenital dacryostenosis are vital components of the workup. A history of excessive watering or discharge from the eye shortly after birth must raise clinical suspicion toward this condition, especially if they are confirmed during the exam [1] [3]. One of the simplest and fastest methods for confirming nasolacrimal duct obstruction is the fluorescein dye test, during which fluorescein-stained saline is applied onto the affected eye [1] [4]. The dye should ideally disappear from the tear film after 5 minutes. If it is retained in a thickened tear strip then it indicates dacryostenosis. Although the diagnosis can be confirmed in virtually all cases by this method, the role of imaging studies is still important, primarily for therapeutic planning if the condition does not resolve spontaneously. Computed tomography (CT), particularly the single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI) and ultrasonography (US) have all been recommended when it comes to imaging assessment of the nasolacrimal duct and adjacent structures [2] [6] [7]. Furthermore, dacryoscintigraphy and dacryocystography have also been described as useful diagnostic methods [8]. Ultrasonography, however, is the most convenient diagnostic method in newborns and children, while more advanced studies are performed if the initial findings are inconclusive [6].

Physicians should consider osteopathic manipulative treatment in the management of dacryostenosis. [ncbi.nlm.nih.gov]

A new treatment protocol will be investigated. [clinicaltrials.gov]

Bergmann to the question by Dr Dave. 1 While I agree that there is a high likelihood that Dr Dave's patient is suffering from recurrent conjunctivitis secondary to congenital dacryostenosis, I do not agree with the recommendations of the authors regarding treatment [jamanetwork.com]

Treatment with antibiotics is needed in this case. A blocked tear duct is almost always correctable, but the treatment depends on the cause and age of the patient. [medindia.net]

[…] is very good with proper treatment Please find comprehensive information on Blocked Tear Duct regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis, and additional useful [dovemed.com]

Prognosis Overall prognosis is excellent. More than 90% of children with these developmental anomalies have improved subjective tearing postoperatively. Moscato EE, Kelly JP, Weiss A. [emedicine.medscape.com]

Prognosis If more conservative approaches fail to clear the obstruction, surgical procedures are available, with success rates greater than 90%. Prevention In many cases, the cause of a lacrimal duct obstruction is not known. [encyclopedia.com]

Prognosis The prognosis for resolution of nasolacrimal duct obstruction by one or more surgical procedures is quite good. The success rate of simple probing is excellent. [eyewiki.aao.org]

Demographic information, etiology of the obstruction, history of lacrimal surgery, type of anesthesia, duration of surgery, incidence of postoperative nasal bleeding and infection, surgical outcomes, and duration of follow-up were recorded. [ncbi.nlm.nih.gov]

Dacryoadenitis References: [1] [2] [3] [4] [5] [6] Dacryostenosis Congenital dacryostenosis Acquired dacryostenosis Etiology Concretions in the NLD Granulomatous diseases: sarcoidosis ; granulomatosis with polyangiitis, tuberculosis Punctal stenosis: [amboss.com]

Dacryostenosis is a term denoting the obstruction of the nasolacrimal duct, which may be either congenital or acquired, depending on the etiology. Epiphora is the most important symptom and may be accompanied by a range of ocular disturbances. [symptoma.com]

Nasolacrimal duct stenosis is a common etiology for epiphora and mattering in infants. [reviewofoptometry.com]

The rate of spontaneous resolution is estimated to be 90% within the first year of life. [1] [2] [3] Etiology The etiology of congenital nasolacrimal duct obstruction is most commonly a membranous obstruction at the valve of Hasner at the distal end of [eyewiki.aao.org]

In this article, we shall briefly review the epidemiology, clinical presentation and the common causes of this condition. Epidemiology Clinical research has shown that nasolacrimal duct obstruction occurs in 2 to 4 out of 100 newborn babies. [eyeplastics.com]

This study provides epidemiologic findings of this common disorder from the largest cohort reported to date. [scienceopen.com]

Diagnosis: Punctal and Canalicular stenosis (dacryostenosis) from Docetaxel EPIDEMIOLOGY 50% of patients receiving weekly docetaxel therapy SIGNS Increased tear lake Evident epiphora Stenosis of punctum Difficulty passing lacrimal dilator or probe SYMPTOMS [webeye.ophth.uiowa.edu]

Pathophysiology Canalization of the nasolacrimal duct system usually is complete by the eighth month of gestation; problems in this normal developmental process can cause any of the above anomalies. [1] Epidemiology Frequency United States Nasolacrimal [emedicine.medscape.com]

A review of the literature highlights key pathophysiologic processes, management options, and musculoskeletal aspects of dacryostenosis. Physicians should consider osteopathic manipulative treatment in the management of dacryostenosis. [ncbi.nlm.nih.gov]

Pathophysiology Canalization of the nasolacrimal duct system usually is complete by the eighth month of gestation; problems in this normal developmental process can cause any of the above anomalies. [1] Epidemiology Frequency United States Nasolacrimal [emedicine.medscape.com]

Nevertheless, the pathophysiology of functional dacryostenosis, i.e., patients with epiphora despite patent lacrimal passages on syringing (so-called functional dacryostenosis) has still not been understood. [rrnursingschool.biz]

To our knowledge, there is no primary prevention for Docetaxel induced dacryostenosis. [clinicaltrials.gov]

Prevention of stenosis would be preferred. In summary, this patient suffers epiphora secondary to punctal and canalicular stenosis from docetaxel therapy. [webeye.ophth.uiowa.edu]

[…] diagnosed thorough a physical exam and fluorescein dye disappearance test Generally, in newborns, the condition improves on its own; but in adults, the treatment of Blocked Tear Duct depends upon the cause of the condition It is typically not possible to prevent [dovemed.com]

We investigate the efficacy of eyedrops containing corticosteroids (CS) versus artificial tears (AT) in patients receiving weekly docetaxel in the prevention of dacryostenosis. [ncbi.nlm.nih.gov]

This may help remove any blockage or discharge and prevent infection. You may hear a soft popping sound when you massage your child's eye. Clean your child's eye with warm water before and after the massage. [drugs.com]

1. Apoznanski TE, Abu-Sbaih R, Terzella MJ, Yao S. Resolution of dacryostenosis after osteopathic manipulative treatment. J Am Osteopath Assoc. 2015;115(2):110-114.
2. Estes JL, Tsiouris AJ, Christos PJ, Lelli GJ. 3-D Volumetric Assessment of the Nasolacrimal Duct in Patients with Obstruction. Ophthal Plast Reconstr Surg. 2015;31(3):211-214.
3. Perveen S, Sufi AR, Rashid S, Khan A. Success Rate of Probing for Congenital Nasolacrimal Duct Obstruction at Various Ages. J Ophthalmic Vis Res. 2014;9(1):60-69.
4. Takahashi Y, Kakizaki H, Chan WO, Selva D. Management of congenital nasolacrimal duct obstruction. Acta Ophthalmol. 2010;88(5):506-513.
5. Cheung LM, Francis IC, Stapleton F, Wilcsek G. Symptom assessment in patients with functional and primary acquired nasolacrimal duct obstruction before and after successful dacryocystorhinostomy surgery: a prospective study. Br J Ophthalmol. 2007;91(12):1671-1674. .
6. Cavazza S, Laffi G, Lodi L, Tassinari G, Dall’Olio D. Congenital dacryocystocele: diagnosis and treatment. Acta Otorhinolaryngol Ital. 2008;28(6):298-301.
7. At'kova EL, Yartsev VD, Tomashevsky IO, Krakhovetsky NN. Treatment choice in dacryostenosis based on single-photon emission computed tomography and X-ray computed tomography findings [Article in Russian]. Vestn Oftalmol. 2016;132(3):15-20.
8. Rózycki R, Kujawa A, Stankiewicz A, Chmielowski K, Murawska M. Dacryocystography and dacryoscintigraphy in diagnosis of naso-lacrimal duct obstruction. [Article in Polish] Klin Oczna. 2002;104(2):107-111.