Lacrimal point stenosis: causes, symptoms, diagnosis, treatment

Narrowing (stenosis) of the lower lacrimal point is one of the common causes of persistent lacrimation. Narrowing of the lacrimal point can be considered when its diameter is less than 0.1 mm.

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Primary stenosis of the lacrimal punctum

Primary stenosis of the lacrimal punctum occurs in the absence of its eversion.

Reasons

• Idiopathic primary stenosis (quite common).
• Herpetic lesion of the eyelids.
• Spread of malignant tumors of the eyelids.
• Cicatricial conjunctivitis and trachoma.
• Systemic use of cytotoxic drugs such as 5-fluorouracil and docetaxel.

Treatment

First, the lacrimal punctum is dilated with a Nettleship dilator. If repeated dilation is unsuccessful, one of the following procedures is used.

• ampullotomy: in one movement a 2 mm vertical incision is made in the back wall of the ampoule;
• two-incision procedure: a vertical and a smaller horizontal incision are made into the ampoule, which provides a much larger opening and a longer lasting effect than the one-incision procedure;
• laser plasty of the lacrimal punctum, in which the lacrimal punctum is opened with an argon laser. This method is preferable in elderly patients with overgrowth of the lacrimal punctum by rapidly growing conjunctival epithelium;
• installation of a drain plug into the lower lacrimal point.

Secondary stenosis of the lacrimal punctum

Occurs with secondary eversion of the lacrimal punctum. Eversion of the inferior lacrimal punctum may be congenital or acquired. May occur with chronic blepharoconjunctivitis, senile atony of the eyelids, etc. The lacrimal punctum is not immersed 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:

• Ziegler cauterization on the palpebral conjunctiva 5 mm below the lacrimal punctum. Subsequent scarring of the coagulated tissue should invert the lacrimal punctum;
• Median conjunctival plasty: a diamond-shaped incision of the tarsal conjunctiva approximately 4 mm high and 8 mm wide, parallel to and below the canaliculi and the lacrimal punctum, the upper and lower edges of the wound are connected with sutures. The connection of the lower eyelid retractors with sutures helps to invert the lacrimal punctum. Once the normal position of the lacrimal punctum has been restored, it is dilated so that it can remain open while establishing the normal passage of tears. If the stenosis recurs, the treatment is the same as for primary stenosis.