Primary acquired nasolacrimal duct obstruction – epidemiology, clinical signs and surgical treatment

Abstract

Aim: The aim of this study was to discuss the epidemiological aspects, clinical picture and the mode of surgical treatment in patients with primary acquired nasolacrimal duct obstruction (PANDO). Patients and methods: Between 1995 and 2016, the Eye Clinic at the University Hospital in Pleven carried out a retrospective analysis on 28 PANDO patients who underwent external dacryocystorhinostomy (DCR). The effect of surgical treatment was assessed based on a history of watery eyes and the tear drainage system’s patency. Only eight of those patients responded to a follow-up examination after surgery for the purposes of this study. Results: The demographics of the evaluated patients were as follows: 17.9% were male, 82.1% were female, 78.6% lived in the city, 92.9% had one impaired eye, and 7.1% had bilateral PANDO. The mean age of the patients at operation was 43.3±5.7 years (SD=14.6). All patients experienced epiphora and discharge; 63.3% had redness of the skin around the lacrimal sac, and 33.3% had episodes of acute dacryocystitis prior to surgery. The surgical success of external DCR was evaluated in nine eyes among the eight patients who responded to the postoperative review. The results showed that the operation was successful in 55.6% of these patients, whereas in 11.1% it had a doubtful effect, and in 33.3% it was not successful. Conclusion: PANDO primarily affects women in their middle years. Cases that are unilateral are more common. External DCR is performed in patients with prolonged epiphora and purulent discharge. 55.6% of the cases are successful. In spite of the outcome, patients expressed great satisfaction with the cosmetic outcome and the disruption of their everyday lives caused by the watering of the eyes.