Lacrimal flow defects
Causes and risk factors
This pathology is caused by a defect in the lacrimal drainage system either at the level of the lacrimal spot (due to its stenosis/closure) or at the level of the lacrimal duct (due to a congenital or acquired stenosis) or at the level of the naso-lacrimal duct.
Which are the symptoms?
The patient complains of hyperlachrymation, which leads to rubbing the eyes so as to create real corneal keratitis (corneal ulcers), where a preoperative eye examination will be necessary.
How is it diagnosed?
After verifying the level of lacrimal drainage deficit through the survey of the lacrimal pathways (Schirmer survey), the most appropriate treatment is selected. In some cases, it is advisable to perform a dacryo-CT with contrast medium, which allows to see the entire pathway of the tear ducts.
How is it treated?
In case of congenital stenosis (closure) of the lacrimal ducts, the child will be positioned, under light general anesthesia, a canalicular prosthesis that must be maintained for about 3 months. This small prosthesis will determine a dilation of the entire pathway of the tear ducts. In case of acquired stenosis (generally secondary to major conjunctivitis), the intervention of choice is the external dacryocystorhinostomy and can be performed under general anesthesia or local anesthesia with sedation. Through a mini-incision is made the removal of a small portion of bone at the base of the nasal wall (no deformities remain), then proceeding to the reconstruction of the tear flow and placing a prosthesis canalicular through the tear ducts that for about a month will be maintained in place.
The patient has a bandage with the eye covered for about 3-4 hours, instead the sutures will be removed after 5-6 days. The patient will have to take antibiotic therapy in tablets for 7-14 days. Normally, no discomfort is reported in maintaining the canalicular prosthesis and the benefit of the disappearance of hyperlacrimation is noted immediately. For congenital stenosis the maintenance of the canalicular prosthesis is generally about 3 months, while for acquired forms it is about 1-3 months, depending on the possible recurrence of occlusion of the lacrimal pathways; the removal of the canalicular prosthesis does not involve pain to the patient and is performed on an outpatient basis.