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. 2012 Jan;19(1):60-9.
doi: 10.4103/0974-9233.92117.

Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system

Mohsen Bahmani Kashkouli  1 , Farzad Pakdel, Victoria Kiavash
Affiliations

Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system

Mohsen Bahmani Kashkouli et al. Middle East Afr J Ophthalmol. 2012 Jan.

Abstract

Epiphora is a common complaint of patients who present to an Ophthalmology Clinic. In many cases, epiphora is due to an obstruction in the lacrimal drainage system. However, a subgroup of symptomatic patients with epiphora has a patent lacrimal drainage system. Such cases are usually termed 'functional obstruction' and / or 'stenosis of the lacrimal drainage system'. Various etiologies and diagnostic and therapeutic approaches have been described in literature, which implies the lack of a standardized approach. This article will review the evolving diagnostic and therapeutic approaches in literature, and in the end, propose a paradigm in approaching this group of patients.

Keywords: Canalicular stenosis; Epiphora; Functional lacrimal obstruction; Nasolacrimal duct; Punctal stenosis; Stenosis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Digital subtraction test of lower eyelid laxity
Figure 2
Figure 2
External lacrimal punctal grading: Grade 0 (a), 1 (b), 2 (c), 3 (d), 4 (e), and 5 (f)
Figure 3
Figure 3
Diagnostic probing and irrigation of the lacrimal drainage system: punctal dilation (a), advancement of probe (b), measuring the soft stop in the canaliculus, up to the tip of the probe (c), and nasolacrimal irrigation (d)
Figure 4
Figure 4
Megalo-caruncle obstructing the punctum before (a) and after (b) lower eyelid pull
Figure 5
Figure 5
Punctal apposition in primary gaze (a) and up-gaze (b)
Figure 6
Figure 6
Subtle punctal ectropion
Figure 7
Figure 7
Proposed paradigm for treatment of epiphora without complete obstruction of the lacrimal drainage system
See this image and copyright information in PMC

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