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  • Title: [Diagnostics and treatment of lacrimal duct diseases : A structured patient-centred care concept].
    Author: Heichel J, Struck HG, Glien A.
    Journal: HNO; 2018 Oct; 66(10):751-759. PubMed ID: 30019233.
    Abstract:
    BACKGROUND: The cardinal symptom of lacrimal stenosis is epiphora and a subjective high level of discomfort due to continuous dacryorrhea. OBJECTIVE: The aim of the current paper is to present a structured review of common diagnostic and therapeutic strategies for lacrimal stenosis. MATERIALS AND METHODS: The most important diagnostic and therapeutic approaches are analysed using the existing literature and by reporting the authors' own experiences. RESULTS: A detailed patient history is crucial for diagnosis of lacrimal disorders. Precise inspection and palpation of the lacrimal and lid region may confirm lacrimal stenosis. Examinations of tear production, tear quality and the properties of the ocular surface are helpful. The most important diagnostic tool is lacrimal duct probing and syringing. Therapy is guided by underlying pathologies. Treatment of congenital lacrimal stenosis follows a staged concept. Epiphora in adults without signs of dacryocystitis should be treated with dacryoendoscopy. Dacryoendoscopy is also a therapeutic option for chronic dacryocystitis, but dacryocystorhinostomy may also be required. Lacrimal trauma should be reconstructed rapidly after the incident by lacrimal intubation. Neoplasia of the lacrimal excretory system requires histological classification to enable multidisciplinary management. CONCLUSION: Basic ophthalmologic diagnostics are complemented by special symptom-based examinations. Due to ongoing improvement of available diagnostic and therapeutic options, patients' care is becoming increasingly individualised.
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