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



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



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Fig. 13.2
Punctal and canalicular abscess


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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.

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


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


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


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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.

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


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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


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Fig. 13.10
A lower lid canalicular tear


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Fig. 13.11
Extensive periocular lacerations involving the lacrimal system


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


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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.

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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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