Primary Acquired Nasolacrimal Duct Obstruction (PANDO) and Secondary Acquired Lacrimal Duct Obstructions (SALDO)

Fig. 13.1
Infective canaliculitis: an example of an infectious SALDO


Fig. 13.2
Punctal and canalicular abscess


Fig. 13.3
CT scan, coronal plane showing extensive pan-sinus and lacrimal involvement by aspergillosis

Inflammatory SALDO

Inflammatory SALDO can include endogenous etiologies like Stevens-Johnson syndrome, cicatricial pemphigoid, sarcoidosis, and Wegener’s granulomatosis (Figs. 13.4 and 13.5). Exogenous etiologies include burns, allergies, use of eye drops like antiviral, radiotherapy, and certain chemotherapeutic agents like 5-fluorouracil and paclitaxel (Figs. 13.6 and 13.7). All the etiologies whether endogenous or exogenous result in response by lacrimal tissues by progressive fibrosis and ultimately result in an obstruction. Instituting measures early on in the inflammatory phase by removing or minimizing the inciting agent, topical and systemic steroids, and recanalization procedures in later phases help in reducing the morbidity associated with epiphora.


Fig. 13.4
Stevens-Johnson syndrome: an example of inflammatory SALDO


Fig. 13.5
Endoscopic view of a nasal cavity extensively involved with Wegener’s granulomatosis


Fig. 13.6
Loss of eyelids and proximal lacrimal system in a case of chemical burns


Fig. 13.7
Radiotherapy-induced SALDO

Traumatic SALDO

Traumatic SALDO is a distinct entity that includes iatrogenic and accidental trauma. Iatrogenic etiologies include probing, intubation, punctal plugs, and sinus surgeries (Figs. 13.8 and 13.9). Accidental traumas involve SALDO secondary to either a soft tissue trauma or a bony trauma. Among the soft tissue injuries, canalicular tears are the most common (Figs. 13.10 and 13.11), and among the bony injuries, specific naso-orbito-ethmoid fractures are known to cause nasolacrimal entrapment and damage (Figs. 13.12 and 13.13) [23]. The specifics of diagnosis and treatment are mentioned in detail in the Chap.​ 16.


Fig. 13.8
Endoscopic photograph of an iatrogenic SALDO caused by producing a false passage during probing


Fig. 13.9
Endoscopic photograph showing horizontal uncinectomy during a sinus surgery. This step has the most potential for causing a traumatic SALDO involving the nasolacrimal duct


Fig. 13.10
A lower lid canalicular tear


Fig. 13.11
Extensive periocular lacerations involving the lacrimal system


Fig. 13.12
Left acute dacryocystitis with a fistula in a case of naso-orbito-ethmoid fracture. Note the past scars of maxillofacial repair


Fig. 13.13
3D reconstructed, volume-rendered CT scan of facial skeleton showing an extensive NOE fracture along with bony lacrimal involvement

Mechanical SALDO

The term mechanical refers to a lacrimal passage physically obstructed anywhere along its entire course by specific agents. These could be endogenous factors like dacryoliths (Fig. 13.14) and migrated punctal plugs or exogenous factors like conjunctivochalasis (Fig. 13.15), sinus mucocele (Fig. 13.16), or caruncular masses (Fig. 13.17). Treatment consists of removing the inciting agent like punctal plugs and excision of caruncular mass or redundant conjunctiva.


Fig. 13.14
CT scan axial image showing left lacrimal sac enlargement with dacryolithiasis

May 26, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Primary Acquired Nasolacrimal Duct Obstruction (PANDO) and Secondary Acquired Lacrimal Duct Obstructions (SALDO)
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