Lacrimal opening stenosis: causes, symptoms, diagnosis, treatment

The constriction (stenosis) of the lower lacrimal point is one of the frequent causes of persistent lacrimation. About narrowing of a lacrimal point it is possible to speak at its diameter less than 0.1 mm.

[1], [2], [3], [4]

Primary stenosis of the lacrimal point

Primary stenosis of the lacrimal point occurs in the absence of its inversion.

Causes

• Idiopathic primary stenosis (often enough).
• Herpetic lesion of the eyelids.
• The spread of malignant tumors of the eyelids.
• Rubs conjunctivitis and trachoma.
• Systemic use of cytotoxic drugs such as 5-fluorouracil and docetaxel.

Treatment

First dilate the lacrimal point with the Nettleship dilator. If the re-expansion fails, resort to one of the following procedures.

• ampulatomy: in one movement a vertical incision of 2 mm is made in the back wall of the ampoule;
• procedure with two cuts: perform a vertical and a smaller horizontal cuts of the ampoule, which provides a much larger opening and a longer lasting effect than the one-cut procedure;
• Laser plasmas are thin, in which the lacrimal point is opened with an argon laser. This method is preferred in elderly patients with lacrimal overgrowth with fast-growing conjunctival epithelium;
• installation of a sewer in the lower lacrimal point.

Secondary stenosis of the lacrimal point

Occurs when the lacrimal point is removed again. The turn of the lower lacrimal point is congenital or acquired. Can occur with chronic blepharoconjunctivitis, senile atony of the eyelids, etc. The lacrimal point is not submerged in the lacrimal lake, but is turned outward.

Treatment in the absence of suspicion of involutional ectropion is carried out in one of the following ways:

• cauterization according to Ziegler on the palpebral conjunctiva is 5 mm below the lacrimal point. Subsequent scarring of the coagulated tissue should invert the tear point;
• conjunctival median plastic: a rhomboid section of the tarsal conjunctiva approximately 4 mm high and 8 mm wide, parallel and below the tubules and lacrimal point, the upper and lower edges of the wound are seamed. The connection of the retractors of the lower eyelid to the sutures facilitates inversion of the lacrimal point. Once the normal position of the lacrimal point is restored, it is expanded so that it can remain open when a normal passage of the tear is established. If the stenosis resumes, the treatment is the same as in the case of primary stenosis.