Symptomatic acquired lacrimal passage obstruction: clinical evaluation of the level of obstruction in adult patients

Abstract

Purpose The aim of this study was to detect the anatomical level of acquired lacrimal passage obstruction among adult patients with epiphora. Patients and methods In a 3-year period, 266 eyes of 223 adult patients with obstructive epiphora were evaluated clinically by probing/irrigation of the lacrimal passages to detect the anatomical level of obstruction. Patients were divided into four groups: punctal, canalicular, nasolacrimal duct (NLD), and mixed groups according to the level of obstruction. Results The age of the patients ranged from 18 to 75 years, and 83.46% of the patients were living in rural areas. Overall, 82% of the patients were females, and 78.99% of them used to apply Kohl as eyeliner cosmetic for an average of 15.62 years. Punctal disorders were detected in 14.67% of the patients, of whom 9.78% had isolated punctal disorders and 4.89% were in the mixed multiple level subgroup. Punctal obstruction represented 69% of the patients with isolated punctal disorders. Canalicular disorders represented 65.4% of all patients, where 70% had isolated canalicular disorder and 30% were in the mixed subgroup. Overall, 39% of all patients had acquired NLD obstruction; 63.5% of them had isolated NLD disorder and 36.5% had multifocal obstruction. Multifocal obstruction of the lacrimal passages was reported in 19.17% of all patients. Conclusion The main site of obstruction was the common canaliculus as two-thirds of the patients had canalicular problems. The second common site of obstruction was the NLD followed by the puncta.