Recognition and management of acute noninfectious dacryocystic retention

Eleven female and 4 male patients presented with 20 documented episodes of acute noninfectious dacryocystic retention. This syndrome complex consists of severe pain and tearing with minimal but tender distention of the lacrimal sac, without signs of inflammation. It is caused by impaction of a dacryolith in the nasolacrimal duct. In our group of patients, the mean age when seen was 39 +/- 14 years, and the mean onset of symptoms occurred at age 35 +/- 13 years. Six episodes resolved spontaneously, and the rest responded to interventional therapy. In six, irrigation relieved the symptoms. One patient each responded to probing, lacrimal intubation, and primary dacryocystorhinostomy (DCR). In three patients, a new technique of percutaneous nasolacrimal duct dilatation using angiographic techniques relieved symptoms. One patient each failed irrigation and percutaneous dilatation and required secondary DCR. Recognition of this presentation permits differentiation of this syndrome from infectious lacrimal obstruction and allows appropriate therapy. In at least some patients, percutaneous nasolacrimal duct dilatation may offer both a method of accurate diagnosis and an initial alternative to more extensive surgery.