Clinical Characteristics of Patients With Symptomatic Nasolacrimal Duct Stenosis

The objective was to characterize symptoms and signs for patients with tearing eye(s) and ipsilateral nasolacrimal duct stenosis (NLDS), as defined by delayed fluorescein disappearance test and ocular reflux of saline during gentle irrigation of a patent drainage system.

Retrospective case-note review of a consistent grading of 4 symptoms and 7 signs, together with estimates of the degree of fluid reflux and nasal fluid passage on gentle saline syringing. Characteristics, including gender differences, were compared for unilateral or bilateral symptoms. A side-to-side comparison was performed in unilateral cases, and assessed for concordance of signs and/or symptoms.

The average age of presentation was 62.4 years in 386 patients (37% male), with a third having unilateral symptoms. Systemic atopy (22%) and chronic nasal disease (27%) were frequent. Patients with unilateral symptoms were significantly younger (males 9.5, females 5.5 years; p < 0.000001) and had shorter symptom duration ( p = 0.0025). Three-quarters of asymptomatic sides had objective evidence of nasolacrimal duct stenosis, and there was significant side-to-side concordance for 7/9 clinical signs. Among 640 symptomatic systems, many of the presenting (subjective) symptoms and/or objective signs showed a significant direct or inverse correlation.

The lack of laterality- or gender bias for symptoms and signs suggests that patients with nasolacrimal duct stenosis might seek treatment for the epiphora per se, rather than for issues with ocular dominance or visual requirements. The close correlation between subjective symptom-severity and objective estimates of signs suggests that thorough clinical assessment can be very reliable, and that several factors probably contribute to symptoms in these patients.