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Dacryostenosis

Lacrimal Duct Obstruction

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. The diagnosis is made after a detailed clinical assessment and fluorescein dye application on the affected eye, whereas imaging studies are necessary for future steps in therapy.


Presentation

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].

Aspiration
  • If the child is anesthetized the saline (colored with fluoroscein typically) can be aspirated with suction. The end of the probe can sometimes be directly observed.[eyewiki.aao.org]
Withdrawn
  • The balloon is inflated according to the manufacturer's specifications and withdrawn. Success of balloon catheter dilation as a primary or secondary procedure has been estimated between 53 and 95%.[eyewiki.aao.org]
Neglect
  • 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.[en.wikipedia.org]

Workup

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].

Lymphocytic Infiltrate
  • Pathology specimens obtained during a repeat dacryocystorhinostomy on the right side revealed a similar lymphocytic infiltrate.[ncbi.nlm.nih.gov]
  • Bilateral lymphocytic infiltrates causing dacryostenosis after bilateral successful dacryocystorhinostomies. Ophthal Plast Reconstr Surg 1988;4:105-8. 35. Anderson NG, Wojno TH, Grossniklaus HE.[djo.harvard.edu]

Treatment

  • Physicians should consider osteopathic manipulative treatment in the management of dacryostenosis.[ncbi.nlm.nih.gov]
  • A new treatment protocol will be investigated.[clinicaltrials.gov]
  • Treatment of occluded nasolacrimal ducts in infants. Arch Ophthal. 1950 Apr;43(4):750-4. Ciftçi F, Akman A, Sönmez M, Unal M, Güngör A, Yaylali V. Systematic, combined treatment approach to nasolacrimal duct obstruction in different age groups.[medresearch.in]
  • General treatment Treatment of congenital lacrimal duct obstruction consists of initial observation for resolution followed by probing of children with persistent duct obstruction.[eyewiki.aao.org]

Prognosis

  • […] 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 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]
  • 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]

Etiology

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

Epidemiology

  • 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]
  • 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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • 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]
  • 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]

Prevention

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

References

Article

  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.

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Last updated: 2019-06-28 12:24