Proximal lacrimal obstructions: a review

Abstract

Purpose: The aims of the review are to summarize the aethiopathogenesis, management and outcomes of different treatments of proximal lacrimal obstructions. Methods: An electronic database (PubMed, MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on proximal lacrimal obstructions was performed. The articles were reviewed along with their relevant cross references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Results: Punctoplasty is as effective as punctal dilatation with monocanalicular or bicanalicular stent in case of punctal stenosis. Dacryocystorhinostomy with retrograde intubation is more effective in case of proximal canalicular obstructions than in case of mid-canalicular obstructions. Trephination and intubation is effective in both mid and distal canalicular obstructions in patients with no associated nasolacrimal duct obstruction. Canaliculodacryocystorhinostomy has a specific indication in case of proximal common canalicular obstruction. Bypass surgery is the preferred treatment if there is no residual patency, however surgical success may not match patient satisfaction. Conclusion: Optimal choice of surgical method depends on identification of the site of obstruction. Mini-invasive techniques should be avoided in cases that would only benefit from standard surgical treatment.

The Agreement Between Syringing, Dacryocystography, and Dacryoendoscopy Findings in Lacrimal Duct Obstruction

“…Thus, different surgical methods for presaccal obstruction are selected depending on the characteristics of the obstruction. 28,29 In LDS obstruction, an accurate diagnosis of the site of obstruction is essential to select the proper surgical method.…”

The Agreement among Syringing, Dacryocystography, and Dacryoendoscopy in Lacrimal Duct Obstruction

“…Thus, different surgical methods for presaccal obstruction are selected based on the obstruction characteristics. 28,29 Therefore, in LDS obstruction, an accurate diagnosis of the obstructed site is essential to select the proper surgical method.…”

The relationship between histopathological features and surgical success in primary acquired punctal stenosis

“…Punctal stenosis is a common lacrimal disorder that causes epiphora due to the narrowing of the external opening of the lacrimal canaliculus. 1 Its prevalence ranges from 8% to 54.3% in patients presenting with epiphora. 1,2 A variety of causes, such as chemical burn, systemic chemotherapy, ocular medications, chronic blepharitis and advanced age, are known to be associated with punctal stenosis; however, most cases remain idiopathic.…”

“…1,2 A variety of causes, such as chemical burn, systemic chemotherapy, ocular medications, chronic blepharitis and advanced age, are known to be associated with punctal stenosis; however, most cases remain idiopathic. 1–3 The relationship between primary nasolacrimal duct obstruction (PANDO) and acquired punctal stenosis has been previously reported. 4–6…”

“…1,2 A variety of causes, such as chemical burn, systemic chemotherapy, ocular medications, chronic blepharitis and advanced age, are known to be associated with punctal stenosis; however, most cases remain idiopathic. [1][2][3] The relationship between primary nasolacrimal duct obstruction (PANDO) and acquired punctal stenosis has been previously reported. [4][5][6] Although the possible causes, epidemiological features and treatment modalities of punctal stenosis have been discussed for a long time, there are only a few histopathological studies investigating the definite pathophysiological mechanism by examining punctal tissue in cases of punctal stenosis.…”