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Lacrimal Duct Stenosis

Lacrimal duct stenosis in a child

  • The lacrimal duct carries tears from the eye to the nose and further to the throat. If the duct is blocked, tears flow onto the cheek.
  • In children, lacrimal duct stenosis may be congenital.

Symptoms

  • Symptoms often starting at the age of 2-4 weeks
  • Watering of the eye continuously or from time to time
  • The conjunctiva easily become infected with consequent discharge from the eye
  • Redness around the eye

Findings

  • Often conjunctivitis
  • The lacrimal punctum may be smaller than normal or displaced away from the ocular surface.
  • Fluorescein test: a drop of fluorescein dye applied to the eye should normally disappear from the eye within 5 minutes and dye should appear in the nostril of the same side as a sign of a patent lacrimal drainage system. An abnormal finding suggests lacrimal duct stenosis.

Treatment

  • The parents should be taught how to perform lacrimal duct massage.
    • Press the medial corner of the eye with a cotton-tipped swab 4-5 times a day, wipe off the discharge that eventually emerges from the lacrimal duct.
    • Chloramphenicol drops should only be used if there is definite purulent discharge from the eye.
    • The treatment should be repeated every time the eye starts clearly watering or producing purulent discharge.
  • If tearing and purulent discharge still continue at the age of over one year, the child should be referred to an outpatient ophthalmology clinic for probing under general anaesthesia Probing or High-Pressure Irrigation for Nasolactimal Duct Obstruction in Infants.
  • In severe cases, a silicone tube is inserted in the lacrimal duct.
  • For older children, dacryocystorhinostomy is considered.

Lacrimal duct stenosis in an adult

Symptoms

  • Tearing and purulent discharge from the eyes
  • Recurrent ophthalmia

Findings

  • Pus or phlegm emerging from the lacrimal punctum on palpation suggests stenosis of the lower lacrimal duct.
  • If a lump is detected on palpation, a tumour should be considered, particularly if the lump is hard or of an abnormal shape, attached to bone or causes malposition of the eyeball.
  • If the lacrimal punctum area is red and irritated and white fluid emerges when squeezing it, there may be canaliculitis.
  • Marked resistance or flow obstruction on lacrimal irrigation indicates partial or complete obstruction.

Treatment

  • In lacrimal duct stenosis, insertion of a silicone tube is often sufficient; in complete obstruction, surgical intervention is often necessary.
  • A GP may perform lacrimal irrigation in an adult according to the following instructions.
    • For the procedure you will need: NaCl solution, a 5-ml syringe, a lacrimal dilator and a disposable lacrimal irrigation tip. Make sure to keep the irrigation tip sterile until inserting it into the lacrimal punctum.
    • Take some NaCl solution in the syringe and attach the irrigation tip.
    • Place the patient in a supine position and sit down at his or her head.
    • Anaesthetize the eye (1 drop of topical oxybuprocaine).
    • Use magnifying loupes, as necessary.
    • Identify the lower lacrimal punctum.
    • Dilate the lacrimal punctum carefully with the lacrimal dilator.
    • Insert the irrigation tip carefully into the lacrimal punctum, advancing it about 2-3 mm in the direction of the eyelid and then carefully turning it towards the nose.
    • Squirt some NaCl solution into the lacrimal duct, keeping the irrigation tip in place.
    • If NaCl solution flows into the throat, the lacrimal duct is patent.