Diagnosis and Treatment of Lacrimal Obstruction

Excessive tearing, or epiphoraEpiphora, is often caused by obstruction within the nasolacrimal system. Anatomy of the nasolacrimal system consists of upper and lower puncta which drain tears from the ocular surface into canaliculi, which then drain to the lacrimal sac, nasolacrimal duct, and then out into nasal cavity. Tests such as the dye disappearance testDye disappearance test, canalicular probing, nasolacrimal irrigation aid in diagnosing and localizing an obstruction within the nasolacrimal system. Factors including inflammation, infection, neoplasms, trauma, drugs, radiation, and congenital factors can lead to stenosis or obstructions at various locations in the nasolacrimal system. Treatments depend on the cause and location of the obstruction. These therapies aim to re-cannulate the lacrimal drainage system via massage, dilation, probing, stentingStenting techniques, incision, trephination, or bypassing the lacrimal system entirely. Thorough history and exam are required to provide an appropriate therapy for treatment of these patients.