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Epiphora or abnormal tearing, occurs because of blockage in the lacrimal drainage system, which impairs normal tear channeling into the nose.

Epiphora
What is Epiphora or abnormal tearing?

Epiphora or abnormal tearing, occurs because of blockage in the lacrimal drainage system, which impairs normal tear channeling into the nose. Recurrent infection may also occur as a result of the stagnation.

Problem

As normal access to the nose for the tears is impaired, a neopassage is defined from the lacrimal sac to the nose.

Etiology

The occurrence of symptoms may be related to congenital or acquired causes. Acquired causes include recurrent dacryocystitis and canaliculitis; dacryolithiasis; lacrimal system tumors; nasal pathology obstructing drainage; and trauma, which may be iatrogenic. An unidentifiable cause contributes to an idiopathic etiology.

Pathophysiology

As a result of the blockage of the nasolacrimal duct, normal tear flow into the nose is impaired. This leads to epiphora. The stagnation of tears in the lacrimal sac and the adjacent conduits promotes infection and its accompanying sequelae.

Presentation

Patients may present to an ophthalmologist with socially unacceptable unilateral or bilateral epiphora interfering with vision. Persistent neglect of the symptom may induce chronic dacryocystitis with purulent drainage from the canaliculi. Inflammation of the skin in the region of the medial canthus may occur with acute exacerbations.

Indications

Indications for dacryocystorhinostomy are as follows:

  • Socially unacceptable epiphora caused by anatomic or functional lacrimal sac or nasolacrimal duct obstruction
  • Chronic dacryocystitis with purulent drainage from the canaliculi
  • Inflammation of the skin overlying the lacrimal sac in the region of the medial canthus
  • Dacryolith formation
  • Benign lacrimal sac mass

Diagnosis of Amblyopia

Since amblyopia usually occurs in one eye only, many parents and children may be unaware of the condition. Far too many parents fail to take their infants and toddlers in for an early comprehensive vision examination and many children go undiagnosed until they have their eyes examined at the eye doctor's office at a later age.

The most important diagnostic tools are the special visual acuity tests other than the standard 20/20 letter charts currently used by schools, pediatricians and eye doctors. Examination with cycloplegic drops can be necessary to detect this condition in the young.

Treatment of Epiphora

The dacryocystorhinostomy operation, which involves fistulization of the lacrimal sac into the nasal cavity, may alleviate the symptoms. The operative approach to the sac may be external or endoscopic. The latter approach may use rigid telescopes or the microscope. The endoscopic approach has several advantages, including the following:

  • It provides a better aesthetic result with no external scar.
  • It allows a one-stage procedure to also correct associated nasal pathology that may be causative.
  • It avoids injury to the medial canthus and/or pathologic scar formation.
  • It preserves the pumping mechanism of the orbicularis oculi muscle.
  • Active infection of the lacrimal system is not a contraindication to surgery.
  • It is especially superior to the external approach in revision surgery.
  • It is much less bloody and messy than the external approach.
  • Because of the facility of the approach, the perioperative time is shorter.
  • The success rate is comparable to the external approach.
The disadvantages of endoscopic surgery include the following:
  • It requires specialized training in nasal endoscopic surgery.
  • The endoscopic equipment is an expense.


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