Canalicular stenosis is a medical condition where the eye’s tear drainage system becomes narrowed or blocked. This often leads to excessive tearing, causing discomfort and interfering with daily activities. It is a common reason for individuals to seek eye care.
Understanding Canalicular Stenosis
The tear drainage system, also known as the lacrimal system, is responsible for moving tears from the eye’s surface into the nasal cavity. This system begins with small openings on the inner corner of the eyelids called puncta. Tears collect here and then enter tiny tubes known as canaliculi, which are located in both the upper and lower eyelids.
From the canaliculi, tears flow into the lacrimal sac, a small reservoir near the bridge of the nose. The tears then drain from the lacrimal sac through the nasolacrimal duct into the nasal cavity. Canalicular stenosis specifically refers to a narrowing or obstruction within these canaliculi, causing tears to overflow the eyelids.
Recognizing the Symptoms and Causes
The primary symptom of canalicular stenosis is epiphora, which is excessive tearing or watery eyes. This tearing can lead to eye irritation, redness, discomfort, and a sticky or crusty discharge. In some instances, recurrent eye infections might also occur due to stagnant tears.
Various factors can contribute to the development of canalicular stenosis. Inflammation from chronic eye conditions like conjunctivitis or blepharitis can lead to scarring and narrowing of the canaliculi. Physical trauma to the eye or surrounding facial area, such as accidents or sports injuries, can also cause direct damage to these delicate structures.
Infections, including viral infections like herpes or bacterial infections, are another potential cause. Certain medications, particularly some chemotherapy drugs, have been linked to canalicular stenosis. Age-related changes can also play a role, as can autoimmune diseases such as Sjögren’s syndrome. While many cases have an identifiable cause, some instances of canalicular stenosis are considered idiopathic, meaning the specific reason for their development remains unknown.
Diagnosis and Treatment Approaches
Diagnosing canalicular stenosis typically begins with a detailed evaluation of the patient’s tearing symptoms and a physical examination of the eye. An ophthalmologist may perform a fluorescein dye disappearance test, where a dye is placed in the eye to observe how quickly it drains. If the dye remains on the eye’s surface for an extended period, it suggests a drainage issue.
To confirm the location and severity of a blockage, lacrimal probing and irrigation may be performed. This involves gently inserting a thin probe into the punctum and flushing saline solution through the tear drainage system. If fluid refluxes from the same punctum, it indicates canalicular stenosis. Imaging studies, such as dacryocystography or CT scans, can provide detailed views of the tear drainage system.
Treatment options for canalicular stenosis range from conservative measures to surgical interventions. Conservative approaches might include warm compresses, gentle massage around the inner eye, and topical antibiotic or steroid eye drops to reduce inflammation if an infection is present. These methods may offer temporary relief but are often less effective for true stenosis.
Surgical procedures are often necessary to restore proper tear drainage. Canalicular dilation involves gently widening the narrowed canaliculi, often followed by the insertion of a temporary silicone stent (intubation) to keep the passage open during healing. The stent helps prevent re-stenosis and is typically removed after a few months. For more extensive blockages, a dacryocystorhinostomy (DCR) might be performed. This procedure creates a new pathway for tears to drain from the lacrimal sac directly into the nasal cavity, bypassing the obstructed area.