Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system

Mohsen Bahmani Kashkouli, Farzad Pakdel, Victoria Kiavash, Mohsen Bahmani Kashkouli, Farzad Pakdel, Victoria Kiavash

Abstract

Epiphora is a common complaint of patients who present to an Ophthalmology Clinic. In many cases, epiphora is due to an obstruction in the lacrimal drainage system. However, a subgroup of symptomatic patients with epiphora has a patent lacrimal drainage system. Such cases are usually termed 'functional obstruction' and / or 'stenosis of the lacrimal drainage system'. Various etiologies and diagnostic and therapeutic approaches have been described in literature, which implies the lack of a standardized approach. This article will review the evolving diagnostic and therapeutic approaches in literature, and in the end, propose a paradigm in approaching this group of patients.

Keywords: Canalicular stenosis; Epiphora; Functional lacrimal obstruction; Nasolacrimal duct; Punctal stenosis; Stenosis.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Digital subtraction test of lower eyelid laxity
Figure 2
Figure 2
External lacrimal punctal grading: Grade 0 (a), 1 (b), 2 (c), 3 (d), 4 (e), and 5 (f)
Figure 3
Figure 3
Diagnostic probing and irrigation of the lacrimal drainage system: punctal dilation (a), advancement of probe (b), measuring the soft stop in the canaliculus, up to the tip of the probe (c), and nasolacrimal irrigation (d)
Figure 4
Figure 4
Megalo-caruncle obstructing the punctum before (a) and after (b) lower eyelid pull
Figure 5
Figure 5
Punctal apposition in primary gaze (a) and up-gaze (b)
Figure 6
Figure 6
Subtle punctal ectropion
Figure 7
Figure 7
Proposed paradigm for treatment of epiphora without complete obstruction of the lacrimal drainage system

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