Evaluation and Management of Acquired Nasolacrimal Duct Obstruction

In the evaluation of patients with acquired tearing, the first step is to assess whether epiphora (tearing caused by insufficient drainage) or lacrimation (hypersecretion of tears) is the cause of tearing. Systematic examination helps isolate the cause of acquired tearing and distinguish patients with obstruction of the lacrimal drainage system from those with secondary hypersecretion.

This chapter discuss the symptoms, clinical characteristics, causes, and management options of acquired nasolacrimal duct obstruction (NLDO).

Etiology

NLDO is the most common cause of persistent epiphora. Acquired NLDO can be classified in to two categories : primary acquired nasolacrimal duct obstruction (PANDO) and secondary acquired nasolacrimal duct obstruction (SANDO).

Primary Acquired Nasolacrimal Duct Obstruction

PANDO most frequently affects middle-aged adults and more women than men. In studies on the osseous nasolacrimal canal, it been observed that women have significantly narrower dimensions in the lower nasolacrimal fossa and middle nasolacrimal duct (NLD), as well as changes in the anteroposterior dimensions of the bony nasolacrimal canal. These changes coincide with osteoporotic changes throughout the body and may explain the higher incidence of PANDO in women. Menstrual and hormonal fluctuations and a heightened immune status have also been suggested as factors that may contribute to the disease process in lacrimal obstruction. These may explain the prevalence of NLDO in middle-aged and elderly women. Hormonal changes that bring about a generalized de-epithelialization in the body may cause the same within the lacrimal sac and duct. An already narrow lacrimal fossa in women may predispose them to obstruction by sloughed-off debris.

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