Disorders of the Lacrimal System

Published on 25/03/2015 by admin

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Last modified 25/03/2015

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Chapter 617 Disorders of the Lacrimal System


Congenital nasolacrimal duct obstruction (CNLDO), or dacryostenosis, is the most common disorder of the lacrimal system, occurring in up to 6% of newborn infants. It is usually caused by a failure of canalization of the epithelial cells that form the nasolacrimal duct as it enters the nose (valve of Hasner). Signs of CNLDO may be present at the time of birth, although the condition may not become evident until normal tear production develops. Signs of CNLDO include an excessive tear lake, overflow of tears onto the lid and cheek, and reflux of mucoid material that is produced in the lacrimal sac. Erythema or maceration of the skin may result from irritation and rubbing produced by dripping of tears and discharge. If the blockage is complete, these signs may be severe and continuous. If obstruction is only partial, the nasolacrimal duct may be capable of draining the basal tear film that is produced. However, under periods of increased tear production (exposure to cold, wind, sunlight) or increased closure of the distal end of the nasolacrimal duct (nasal mucosal edema), tear overflow may become evident or may increase.

Infants with CNLDO may develop acute infection and inflammation of the nasolacrimal sac (dacryocystitis), inflammation of the surrounding tissues (pericystitis), or rarely periorbital cellulitis. With dacryocystitis, the sac area is swollen, red, and tender, and patients may have systemic signs of infection such as fever and irritability.

The primary treatment