“…In infectious viral cases, the infl ammation extends beyond the mucosal epithelium into the deeper elastic layer, whereas in cases caused by microbes, it never extends into the elastic layer, and no stenosis of the lacrimal apparatus is observed. 15,17,24 In addition, narrow drainage structures such as the canaliculi are vulnerable to obstruction because of their mucosal wall proximity if they become infl amed. 25 Another possible mechanism is that an infl ammatory membrane caused by an adenovirus may produce adhesions between opposing raw surfaces of the lacrimal outlet system.…”