dacryostenos

Dacryostenosis, or nasolacrimal duct stenosis, is the narrowing or obstruction of the tear drainage pathway, from the puncta through the canaliculi, lacrimal sac, and nasolacrimal duct, to the nasal cavity. It leads to impaired tear drainage and may cause epiphora (excessive tearing), recurrent conjunctivitis, and mucopurulent discharge when inflammation is present. Dacryostenosis can be congenital or acquired, and any segment of the drainage system may be involved.

Congenital dacryostenosis is common in infants and results from incomplete canalization of the nasolacrimal duct. Many cases resolve spontaneously within the first year of life. Acquired dacryostenosis occurs later and can follow chronic inflammation or infection, trauma, prior surgery, inflammatory diseases, tumors, or age-related stenosis.

Clinical presentation typically includes persistent tearing, eye irritation, and sometimes sticky eyelids, especially in the morning. Recurrent infections of the conjunctiva or lacrimal sac may occur. Physical examination may reveal a patent punctum with a dilated lacrimal sac on gentle palpation; syringing helps determine the level of obstruction.

Diagnosis is clinical, supported by probing and irrigation to assess patency. Imaging such as dacryocystography or dacryoscintigraphy may be used in uncertain cases to delineate the site and extent of obstruction.

Management ranges from conservative to surgical. In infants, lid hygiene, lacrimal sac massage, and treatment of infection are first steps, with probing and, if needed, silicone stent intubation for persistent cases. In adults with distal obstruction, external or endoscopic dacryocystorhinostomy offers a definitive solution. Canalicular or punctal stenosis may require specialized techniques, including dilatation, punctoplasty, or conjunctivodacryocystorhinostomy in selected cases. Prognosis improves with appropriate level-specific treatment and higher success rates for congenital proximal obstructions treated early.