Dacryostenosis

Excerpt

Dacryostenosis is an acquired or congenital condition resulting from nasolacrimal duct obstruction (NLDO), which causes epiphora or watery eyes. The term "dacryostenosis" is derived from the Greek words dákryon ("tear") and stenósis ("narrowing"), which refers to the congenital or acquired narrowing of the nasolacrimal duct. The ocular surface remains consistently moistened by tears produced by specialized lacrimal glands. After nourishing the ocular surface, these tears flow into the nose through the nasolacrimal duct.

The secretory lacrimal system relies on the integral function of the lacrimal glands. When addressing dacryostenosis, it is essential to grasp the mechanisms of tear production and the anatomy of the tear drainage system (see Image. The Lacrimal Drainage Pathway). The 4 key anatomical components that constitute the excretory system are listed below.

1. The puncta: These are orifices situated on the surface of eyelids.

2. The canaliculi: These are small channels connecting the puncta with the nasolacrimal sac.

3. The nasolacrimal sac: This serves as a reservoir for tears that overflow.

4. The nasolacrimal duct: This carries tears from the eyes into the nasal cavity.

Epiphora is a condition that results from anomalies affecting any part of the excretory system and causing excessively watery eyes and an overflow of tears.

The congenital form of dacryostenosis is the most prevalent cause of persistent tearing and ocular discharge, affecting nearly 6% of all infants. This condition results from abnormal canalization of the nasolacrimal duct, in utero, at the end closest to the nose.

In contrast, the acquired form of dacryostenosis can be classified as either primary or secondary, depending on the underlying cause. The causes of primary acquired NLDO (PANDO) include inflammation, fibrosis, mucosal edema, vascular congestion, stasis, infections, or trauma to the lacrimal apparatus, which can result in partial or total obstruction of the duct later in life. Menstrual hormonal changes, osteoporosis, and the gradual narrowing of the lacrimal duct, particularly in females older than 40, contribute to increased susceptibility. Other potential underlying factors include infections, inflammation, neoplasms, and mechanical obstruction.

The presence of a mucoid discharge and persistent tearing are the 2 classic clinical symptoms of dacryostenosis. These symptoms typically appear in newborns during the first few weeks to months of life. Although dacryostenosis is generally benign, untreated cases can advance to recurrent conjunctivitis and dacryocystitis, potentially causing various complications such as stained tears, frequent eye infections, preseptal or orbital cellulitis, sepsis, meningitis, or brain abscess in both children and adults. Therefore, it is crucial to address dacryostenosis promptly to prevent the onset of severe medical problems.