Lacrimal Apparatus Disorders include epiphora which may be described as an abnormal overflow of tears down the cheek due to excess secretion of tears or obstruction of the lacrimal duct and dacryocystitis, an infection of the lacrimal sac.

Causes of epiphora include stenosis of the nasolacrimal duct. In most cases, stenosis is usually acquired from viral infections such as varicella, herpes simplex, and adenovirus. Some drugs and diseases also cause obstruction and stenosis of the nasolacrimal duct. Infection of the lacrimal sac (dacryocystitis) is usually secondary to obstruction. A stone in the duct or trauma could be the cause of obstruction. The infective organism is usually Staphylococcus aureus or, occasionally, B-hemolytic streptococci.

Manifestations of major disorders of the lacrimal excretory system are as follows:

• Dacryocystitis - This is an infection of the lacrimal sac, usually unilateral and secondary to obstruction. The main symptoms are tearing and discharge. During the acute phase, there is tenderness, pain, swelling, and inflammation over the tear sac area. Pus can be expressed from the sac. When the condition is chronic, the only sign is tearing and mucoid discharge on pressure over the area of the sac.

• Canalicular system stenosis - The usual complaints are of an irritated and red eye with a slight discharge that can be expressed from the canaliculus.

A microscopic examination and staining of material expressed from the canaliculus or the tear sac or both can identify the infectious agent. Cultures will be made as a basis for treatment. X-rays are used prior to surgery to identify the obstruction site.

The acute form of dacryocystitis is usually treated with systemic antibiotics that have been identified as appropriate through microscopic examination. Hot compresses may be helpful and any abscess will be incised and drained.

The chronic form of dacryocystitis is often held latent with antibiotic drops. The duct may be dilated; however, the cure is to relieve the obstruction in the nasolacrimal duct with an operation (dacrocystorhinostomy), or endoscopy, and the use of laser radiation. If the obstruction is in the common canalicular, then stents may be placed in the passages for 3 to 6 months.

Total canalicular obstruction may necessitate the placement of an artificial tear duct for relief of epiphora.

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