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Involutional stenosis is probably the most common cause of nasolacrimal duct obstruction in older people. It affects women twice as frequently as men. Although the inciting event in this process is unknown, clinicopathologic study suggests that compression of the lumen of the nasolacrimal duct is caused by inflammatory infiltrates and edema.
Tears are produced by the lacrimal gland, situated just outside the eye. Blinking the eyelids distributes the tears to keep the eyes moist, clean and lubricated. Excess tears are drained via the punctum through the tiny channels called canaliculi located on the inner side of the eyes into the tear sac, from there to the tear duct, the nose and finally down the throat.
Dacryoscintigraphy (DSG), also known as lacrimal scintigraphy, is a nuclear medicine technique for imaging the lacrimal apparatus. It is used to identify obstructions, for example in the lacrimal duct , nasal cavity or nasolacrimal duct .
[1] [2] The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold (valve of Hasner or plica lacrimalis). [3]
Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of the lacrimal sac. [1] The term derives from Greek dákryon 'tear' cysta 'sac' and -itis 'inflammation'. [2] It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora.
With the advent of nasal endoscopes, endoscopic dacryocystorhinostomy is becoming popular. In this procedure, a nasal endoscope is used to visualise the lacrimal sac through the nasal cavity. The bone covering the lacrimal sac is nibbled out. The medial wall of the sac is incised or excised, facilitating drainage of tears into the nasal cavity.
Causes of epiphora are any that cause either overproduction of tears or decreased drainage of tears, resulting in tearing onto the cheek. [2] This can be due to ocular irritation and inflammation (including trichiasis and entropion) or an obstructed tear outflow tract, which is divided according to its anatomical location (i.e., ectropion, punctal, canalicular or nasolacrimal duct obstruction).
The lacrimal canaliculi (sg.: canaliculus) are the small channels in each eyelid that drain lacrimal fluid, from the lacrimal puncta to the lacrimal sac. This forms part of the lacrimal apparatus that drains lacrimal fluid from the surface of the eye to the nasal cavity.
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