Definition
In lacrimal duct stenosis, the lacrimal duct is closed for various reasons, which hinders the drainage of tear fluid. The tear fluid is produced in the lacrimal gland, which is located at the top of the eye. From here, the tear fluid reaches the surface of the eye, where it protects the eye from drying out and the penetration of pathogens.
With the help of the eyelid blink, the tear fluid is transported over the entire eye surface up to the inner corner of the eyelid. The tear fluid is then normally drained off through the lacrimal points, tear ducts, lacrimal sac and finally through the nasolacrimal duct into the nose. In case of lacrimal duct stenosis, this outflow is disturbed and tear fluid accumulates in the eye, causing the eye to water constantly. On the one hand, this can be very annoying, on the other hand, the accumulation of tear fluid can cause infections of the eye with bacteria, which is why persistent lacrimal duct stenosis should always be treated.
How often does lacrimal duct stenosis occur?
Lacrimal duct stenosis is a common clinical picture. About 30 percent of newborns are affected by congenital lacrimal duct stenosis. In the majority of affected newborns, however, the condition subsides rapidly.
The incidence of acquired lacrimal duct stenosis increases with age and affects one in three people over the age of 90. Lacrimal duct stenosis is a disorder in the drainage system of the lacrimal fluid. This leads to constant tears and the formation of a lacrimal lake in the affected eye.
If too much tear fluid accumulates, it leads to an overflow of tear fluid over the edge of the eyelid, which is known as “tear dripping” or “epiphora”. Since the tear fluid also stops in the lacrimal sac, because it cannot flow off via the lacrimal duct and the nasolacrimal duct, the lacrimal sac may be infected with bacteria. Frequent symptoms are then symptoms such as secretion of purulent secretion when pressure is exerted on the inner eyelid angle, as well as redness and swelling of the inner eyelid angle.
Purulent crusts can also form at the eyelid angle. As a complication, the inflammation can spread to the surrounding soft tissue, which is then called phlegmon. Typical symptoms of patients with lacrimal duct stenosis are the dripping of tears (epiphora) and constant watering of the affected eye.
However, these symptoms can also occur in other eye diseases, which must be excluded before a diagnosis of lacrimal duct stenosis can be made. Important for the diagnosis of lacrimal duct stenosis is a careful questioning of the patient about his or her medical history, as well as an ophthalmological examination of the eye, which includes a close examination of the eyelids, lacrimal points and conjunctiva of the affected eye. In some cases, e.g. for the exact localization of the lacrimal duct stenosis, imaging procedures such as ultrasound, X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) are also used to visualize the draining lacrimal duct.
In the case of acquired lacrimal duct stenosis, an additional examination by an ear, nose and throat specialist may be necessary if polyps, tumors or a malposition of the nasal septum are suspected as the cause of the lacrimal duct stenosis. This is usually done during an endoscopy, during which the structures in the nose, which may obstruct the drainage of tear fluid, can be very well visualized. There are various measures that can be considered for the treatment of lacrimal duct stenosis.
In congenital lacrimal duct stenosis, there is often a spontaneous regression of the Hasner membrane within the first year of life and thus an improvement in the outflow of tear fluid. The opening of the lacrimal duct can be promoted by daily massages of the lacrimal duct with the index finger. The outflow of tear fluid can also be improved by using decongestant eye drops and nasal drops.
Antibiotic eye drops are used to treat infections of the eye. It should be borne in mind that the use of eye drops and nasal drops is by no means suitable for long-term therapy. Instead, if there is no improvement in symptoms after the sixth month of life, other procedures such as hyperbaric irrigation or probing of the draining tear ducts should be used.
If the nasolacrimal duct cannot be opened in this way, various surgical procedures are available to allow the regular drainage of tear fluid.If symptoms such as tears or infections become more frequent, the above-mentioned measures such as hyperbaric irrigation, probing and surgery are recommended before the age of six months. In the case of acquired lacrimal duct stenosis, additional different treatment options can be used depending on the cause. These include the removal of nasal polyps and tumors or correction of a malposition of the nasal septum.
A lacrimal duct stenosis can be congenital or acquired. Congenital lacrimal duct stenosis is a degeneration of tissue at the transition from the lacrimal duct to the nose. Normally, the tissue present here recedes before the child is born, but in some cases this regression does not occur, or does not occur at all.
This tissue, which is a barrier to the tear fluid, is called the Hasner membrane. Due to the presence of a Hasner membrane, the tear fluid cannot drain off and the affected newborns become conspicuous by constant eye tears. However, lacrimal duct stenosis can also occur at an advanced age.
Reasons for an acquired, i.e. not congenital, lacrimal duct stenosis are, for example, injuries in the area of the draining lacrimal duct, such as lacrimal tubules or the lacrimal-nasal duct, which impair the drainage of tear fluid. These can include bite wounds or cuts. Previous inflammation of the lacrimal duct can also be the cause of acquired lacrimal duct stenosis.
However, not only diseases of the lacrimal duct itself, but also diseases of the nose, such as polyps, tumors, a malposition of the nasal septum or swelling of the nasal mucous membrane due to a cold can obstruct the nasolacrimal duct and thus also cause a disturbance in the drainage of tear fluid. In many cases, it is not possible to prevent lacrimal duct stenosis. Acquired lacrimal duct stenosis can be prevented by avoiding injuries and frequent inflammation of the lacrimal duct, or, if necessary, by removing polyps and tumors in the nose.
However, in congenital lacrimal duct stenosis, rapid treatment is particularly important to prevent complications such as eye infections. The prognosis for congenital lacrimal duct stenosis is good. A cure, through the spontaneous regression of the Hasner membrane within the first year of life, is frequent.
The healing process can be promoted by various measures, such as massages or probing of the lacrimal duct. The prognosis of acquired lacrimal duct stenosis depends on the cause of the occlusion. Symptoms/complaints The occlusion of the nasolacrimal duct causes not only mucus to accumulate but also the tear fluid, which normally drains from the eye via the nasolacrimal duct into the nose.
This leads to the symptoms typical of lacrimal duct stenosis, such as constant tearing of the eye and overflowing of the tear fluid over the edge of the eyelid, which is called tear trickle or epiphora. Diagnosis The diagnosis of lacrimal duct stenosis in newborns is usually made on the basis of the typical clinical symptoms, such as constant tearing and dripping of tears in the affected eye. In some cases, additional examinations with imaging techniques such as ultrasound, x-rays, computed tomography (CT) or magnetic resonance imaging (MRI) are necessary to diagnose lacrimal duct stenosis.
Therapy If the irrigation and probing of the lacrimal ducts are also unsuccessful, there are various surgical measures available to ensure the proper drainage of tear fluid. A narrowing of the lacrimal ducts, a lacrimal duct stenosis, can also occur in adulthood. However, the causes of lacrimal duct stenosis in adults are different from those of the newborn baby.
Cause Often, injuries or previous inflammation in the area of the lacrimal duct are the cause of lacrimal duct stenosis in adults. But also diseases of the nose, such as polyps, tumors, a malposition of the nasal septum or swelling of the nasal mucosa due to rhinitis can obstruct the lacrimal duct and thus hinder the drainage of tear fluid. Symptoms A stenosis of the lacrimal duct is characterized by a disruption in the outflow of tear fluid, which leads to constant tearing in the affected eye and to an overflowing of tear fluid over the edge of the eyelid (lacrimation or epiphora).
In the lacrimal sac, too, the obstructed drainage can cause tear fluid to stop, which can promote infection of the lacrimal sac with bacteria.In the course of an inflammation of the lacrimal ducts, symptoms such as secretion of purulent secretion when pressure is applied to the inner eyelid angle, as well as redness and swelling of the inner eyelid angle are then added. Diagnosis The diagnosis is made on the basis of the typical symptoms. If necessary, examinations with imaging techniques such as ultrasound, X-ray, computed tomography (CT), magnetic resonance imaging (MRI) or endoscopy of the nose may be necessary to diagnose lacrimal duct stenosis or its causes.
Therapy For the treatment of lacrimal duct stenosis in adults, irrigation and probing of the lacrimal ducts, as well as various surgical measures are considered, as in the case of lacrimal duct stenosis in newborns. In addition, depending on the cause of the lacrimal duct stenosis, the removal of nasal polyps and tumors or correction of a malposition of the nasal septum may be necessary.
