Approach to the patient with tear duct pathology: Surgical indications
Abstract Introduction and objective: To carry out a update review on the current diagnoses and therapeutic indications of tear duct obstruction (NLO) and propose a simple, early and practical clinical management. Method: Review of published literature regarding NLO and the current way of approaching this pathology. Results: The alteration of the natural tear flow (epiphora) may have a functional or anatomical origin. Functional obstructions are secondary to the failure of the tear pump, while the anatomical obstruction is caused by a physical obstacle along the tear duct that prevents drainage in the nasal cavity. Pseudoepiphora (tearing), on the other hand, is secondary to the presence of pathology of the ocular surface (dry eye) or secondary to mechanical, chemical, infectious or psychic stimuli. Up to 40% of patients referred to ophthalmology consultations for tearing / epiphora, have a dry eye with tear reflex, without anatomical obstruction of the tear duct. Conclusions: Tearing is one of the most frequent symptoms in ophthalmology consultations. However, the etiological factors that can lead to this complaint are very numerous. A multidisciplinary study (ophthalmology and ENT) is essential to make a correct etiological diagnosis. The success of tear surgery lies in a correct surgical indication.
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1. Shen GL, Ng JD, Ma XP. Etiology, diagnosis, management and outcomes of epiphora referrals to an oculoplastic practice. Int J Ophthalmol. 2016;9(12):1751-5.
2. Nemet AY. The Etiology of Epiphora: A Multifactorial Issue. Semin Ophthalmol. 2016;31(3):275-9.
3. Ulusoy MO, Kivanc SA, Atakan M, Akova-Budak B. How Important Is the Etiology in the Treatment of Epiphora? J Ophthalmol. 2016;2016:1438376.
4. Mainville N, Jordan DR. Etiology of tearing: a retrospective analysis of referrals to a tertiary care oculoplastics practice. Ophthalmic Plast Reconstr Surg. 2011;27(3):155-7.
5. Ali MJ. Principles and Practice of Lacrimal Surgery: Springer 2016. 384 p.
6. Isloor SD. Lacrimal Drainage Surgery First Edition ed2014. 108 p.
7. Cohen AJ, Mercandetti M, Brazzo BG. The Lacrimal System. Second Edition ed2014. 216 p.
8. Shams PN, Chen PG, Wormald PJ, Sloan B, Wilcsek G, McNab A, et al. Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy. JAMA Ophthalmol. 2014;132(9):1127-32.
9. Murube J. Basal, reflex, and psycho-emotional tears. Ocul Surf. 2009;7(2):60-6.
10. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-83.
11. Sahlin S, Rose GE. Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems. Orbit. 2001;20(3):173-9.
12. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990;177(3):687-90.
13. Moscato EE, Dolmetsch AM, Silkiss RZ, Seiff SR. Silicone intubation for the treatment of epiphora in adults with presumed functional nasolacrimal duct obstruction. Ophthalmic Plast Reconstr Surg. 2012;28(1):35-9.
14. Goyal R, Gupta S. Analysis of 104 cases of endonasal dacryocystorhinostomy in a tertiary care hospital: a prospective study. Indian J Otolaryngol Head Neck Surg. 2014;66(1):102-5.
15. Galindo-Ferreiro A, Dufaileej M, Galvez-Ruiz A, Khandekar R, Schellini SA. Dacryocystectomy: Indications and Results at Tertiary Eye Hospital in Central Saudi Arabia. Semin Ophthalmol. 2018;33(5):602-5.
16. Garcia-Catalan MR, Jerez-Olivera E, Benitez-Del-Castillo-Sanchez JM. [Dry eye and quality of life]. Arch Soc Esp Oftalmol. 2009;84(9):451-8.
17. Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
18. Cuthbertson FM, Webber S. Assessment of functional nasolacrimal duct obstruction--a survey of ophthalmologists in the southwest. Eye (Lond). 2004;18(1):20-3.
19. Lefebvre DR, Freitag SK. Update on imaging of the lacrimal drainage system. Semin Ophthalmol. 2012;27(5-6):175-86.
20. Singh S, Ali MJ, Paulsen F. Dacryocystography: From theory to current practice. Ann Anat. 2019;224:33-40.
21. Beloglazov VG, Filimonov GP, At'kova EL, Abdurakhmanov GA, Normatova NS. [Magnetic resonance imaging in the diagnosis of lacrimal tract pathology]. Vestn Oftalmol. 2007;123(1):17-22.
22. Eustis HS, Babiuch A. Botulinum toxin injection into the lacrimal gland for treatment of proximal nasolacrimal duct obstructions in children. J Pediatr Ophthalmol Strabismus. 2014;51 Online:e75-7.
23. Trakos N, Mavrikakis E, Boboridis KG, Ralidis M, Dimitriadis G, Mavrikakis I. A modified technique of retrograde intubation dacryocystorhinostomy for proximal canalicular obstruction. Clin Ophthalmol. 2009;3:681-4.
24. Schlachter DM, Richani K, Black EH. Diode Laser-Assisted Endocanalicular Dacryocystorhinostomy: A Prospective Study. Ophthalmic Plast Reconstr Surg. 2016;32(3):183-6.
25. Peter NM, Pearson AR. External dacryocystorhinostomy for the treatment of epiphora in patients with patent but non-functioning lacrimal systems. Br J Ophthalmol. 2010;94(2):233-5.
26. Singh S, Nair AG, Alam MS, Mukherjee B. Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphora. Oman J Ophthalmol. 2019;12(2):104-7.
27. Alsuhaibani AH, Eid SA. Botulinum toxin injection and tear production. Curr Opin Ophthalmol. 2018;29(5):428-33.
28. Rose GE. Lacrimal drainage surgery in a patient with dry eyes. Dev Ophthalmol. 2008;41:127-37.
2. Nemet AY. The Etiology of Epiphora: A Multifactorial Issue. Semin Ophthalmol. 2016;31(3):275-9.
3. Ulusoy MO, Kivanc SA, Atakan M, Akova-Budak B. How Important Is the Etiology in the Treatment of Epiphora? J Ophthalmol. 2016;2016:1438376.
4. Mainville N, Jordan DR. Etiology of tearing: a retrospective analysis of referrals to a tertiary care oculoplastics practice. Ophthalmic Plast Reconstr Surg. 2011;27(3):155-7.
5. Ali MJ. Principles and Practice of Lacrimal Surgery: Springer 2016. 384 p.
6. Isloor SD. Lacrimal Drainage Surgery First Edition ed2014. 108 p.
7. Cohen AJ, Mercandetti M, Brazzo BG. The Lacrimal System. Second Edition ed2014. 216 p.
8. Shams PN, Chen PG, Wormald PJ, Sloan B, Wilcsek G, McNab A, et al. Management of functional epiphora in patients with an anatomically patent dacryocystorhinostomy. JAMA Ophthalmol. 2014;132(9):1127-32.
9. Murube J. Basal, reflex, and psycho-emotional tears. Ocul Surf. 2009;7(2):60-6.
10. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276-83.
11. Sahlin S, Rose GE. Lacrimal drainage capacity and symptomatic improvement after dacryocystorhinostomy in adults presenting with patent lacrimal drainage systems. Orbit. 2001;20(3):173-9.
12. Munk PL, Lin DT, Morris DC. Epiphora: treatment by means of dacryocystoplasty with balloon dilation of the nasolacrimal drainage apparatus. Radiology. 1990;177(3):687-90.
13. Moscato EE, Dolmetsch AM, Silkiss RZ, Seiff SR. Silicone intubation for the treatment of epiphora in adults with presumed functional nasolacrimal duct obstruction. Ophthalmic Plast Reconstr Surg. 2012;28(1):35-9.
14. Goyal R, Gupta S. Analysis of 104 cases of endonasal dacryocystorhinostomy in a tertiary care hospital: a prospective study. Indian J Otolaryngol Head Neck Surg. 2014;66(1):102-5.
15. Galindo-Ferreiro A, Dufaileej M, Galvez-Ruiz A, Khandekar R, Schellini SA. Dacryocystectomy: Indications and Results at Tertiary Eye Hospital in Central Saudi Arabia. Semin Ophthalmol. 2018;33(5):602-5.
16. Garcia-Catalan MR, Jerez-Olivera E, Benitez-Del-Castillo-Sanchez JM. [Dry eye and quality of life]. Arch Soc Esp Oftalmol. 2009;84(9):451-8.
17. Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
18. Cuthbertson FM, Webber S. Assessment of functional nasolacrimal duct obstruction--a survey of ophthalmologists in the southwest. Eye (Lond). 2004;18(1):20-3.
19. Lefebvre DR, Freitag SK. Update on imaging of the lacrimal drainage system. Semin Ophthalmol. 2012;27(5-6):175-86.
20. Singh S, Ali MJ, Paulsen F. Dacryocystography: From theory to current practice. Ann Anat. 2019;224:33-40.
21. Beloglazov VG, Filimonov GP, At'kova EL, Abdurakhmanov GA, Normatova NS. [Magnetic resonance imaging in the diagnosis of lacrimal tract pathology]. Vestn Oftalmol. 2007;123(1):17-22.
22. Eustis HS, Babiuch A. Botulinum toxin injection into the lacrimal gland for treatment of proximal nasolacrimal duct obstructions in children. J Pediatr Ophthalmol Strabismus. 2014;51 Online:e75-7.
23. Trakos N, Mavrikakis E, Boboridis KG, Ralidis M, Dimitriadis G, Mavrikakis I. A modified technique of retrograde intubation dacryocystorhinostomy for proximal canalicular obstruction. Clin Ophthalmol. 2009;3:681-4.
24. Schlachter DM, Richani K, Black EH. Diode Laser-Assisted Endocanalicular Dacryocystorhinostomy: A Prospective Study. Ophthalmic Plast Reconstr Surg. 2016;32(3):183-6.
25. Peter NM, Pearson AR. External dacryocystorhinostomy for the treatment of epiphora in patients with patent but non-functioning lacrimal systems. Br J Ophthalmol. 2010;94(2):233-5.
26. Singh S, Nair AG, Alam MS, Mukherjee B. Outcomes of lacrimal gland injection of botulinum toxin in functional versus nonfunctional epiphora. Oman J Ophthalmol. 2019;12(2):104-7.
27. Alsuhaibani AH, Eid SA. Botulinum toxin injection and tear production. Curr Opin Ophthalmol. 2018;29(5):428-33.
28. Rose GE. Lacrimal drainage surgery in a patient with dry eyes. Dev Ophthalmol. 2008;41:127-37.
Diez-Montero, C., Marqués-Fernandez, V., De Las Heras Florez, P., & Galindo-Ferreiro, A. (2020). Approach to the patient with tear duct pathology: Surgical indications. Revista ORL, 12(2), 67–78. https://doi.org/10.14201/orl.24145
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