Acquired Naso-Lacrimal Duct Obstruction

An obstruction in the lower part of the naso-lacrimal duct (acquired naso-lacrimal duct obstruction) is a fairly common problem in the adult, especially in the female population 50 years of age or older because of their particular anatomy of this region. In the vast majority of the patients we cannot find a possible cause that determined the obstruction, hence the term of ‘primary’ acquired naso-lacrimal duct obstruction (PANDO). Occasionally, the duct may be occluded as a consequence of a facial trauma with the nasal bones involved or a surgical procedure in the nose (rhino-septoplasty, turbinectomy etc).

Symptoms
The most common symptom of a PANDO is the so-called ‘epiphora’, which refers to the constant tearing with tears building up in the eyelid fissure and eventually running down the cheeks, requiring frequent dabbing of the tears. One or both eyes can be affected, even at the same time. Frequently, affected patients refer that they always travel with a paper tissue in their hands do dab their tears. Moreover the sight may result impaired from the excessive fluid accumulation on the surface of the eye. The patients can have frequent recurrent episodes of ‘red eye’ (conjunctivitis), mucus secretion.

Occasionally, more severe episode of inflammation with swelling and pain between the nose and the eye (in the anatomical location of the lacrimal sac), called ‘acute dacryocystitis’ may occur repeatedly and require systemic treatment with antibiotic and even hospitalization.

Diagnosis
A medical consult with a specialist in lacrimal surgery (usually an ophthalmologist with a sub-specialty training in oculoplastic surgery) is required to establish the appropriate diagnosis and rule out other conditions.

Normally, after a routine evaluation of the eye and ocular surface, a simple lacrimal siringing is the most reliable test to establish the diagnosis. A standard nasal exam is routinely performed by the oculoplastic specialist. Radiological exams are not required in the vast majority of cases.

Treatment
Once the diagnosis os PANDO is established, the final treatment is a surgical procedure called ‘dacryocystorhinostomy’ and can be performed through an external approach (a small skin incision over the lateral part of the nose that leaves invisible scar) or though and endonasal endoscopic approach.

The surgical technique is well standardized, is performed under local anesthesia with the help of intravenous monitored sedation, the surgical time takes less than 20 minutes and the patient can be discharge from the surgical facility within two hours from the end of surgery. The success rate is well over 90% in the external approach in the hands of an expert lacrimal surgeon.

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