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Abstract

In this chapter, both deficiency of tears and excess tear production in infancy are discussed. A few external anomalies of the lacrimal drainage system are described. Major attention is given to the most common abnormality of the lacrimal system in childhood, congenital nasolacrimal duct obstruction, its natural course, and its management.

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References

  1. Sjögren H. The lacrimal secretion in newborn premature and fully developed children. Acta Ophthalmol. 1955;33(5):557–60.

    Article  Google Scholar 

  2. Cassady J. Dacryocystitis of infancy. Am J Ophthalmol. 1948;31(7):773–80.

    Article  CAS  PubMed  Google Scholar 

  3. Duke-Elder W. Keratitis sicca. Br J Ophthalmol. 1930;14(2):61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sjögren H, Eriksen A. Alacrimia congenita. Br J Ophthalmol. 1950;34(11):691.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Keith CG, Boldt DW. Congenital absence of the lacrimal gland. Am J Ophthalmol. 1986;102(6):800.

    Article  CAS  PubMed  Google Scholar 

  6. Smith RS, Maddox SF, Collins BE. Congenital alacrima. Arch Ophthalmol. 1968;79(1):45–8.

    Article  CAS  PubMed  Google Scholar 

  7. Gupta N, Farooqui JH, Agni M, Kumar A, Sharma M, Mathur U. Alacrima, a rare cause of pediatric dry eye. J Am Assoc Pediatr Ophthalmol Strabismus. 2018;22: 233.

    Article  Google Scholar 

  8. Adams J, Schaaf C. Diagnosis and genetics of alacrima. Clin Genet. 2018;94(1):54–60.

    Article  CAS  PubMed  Google Scholar 

  9. Riley CM, Day RL, Greeley DM, Langford WS. Central autonomic dysfunction with defective lacrimation: I. Report of five cases. Pediatrics. 1949;3(4): 468–78.

    CAS  PubMed  Google Scholar 

  10. Dunnington JH. Congenital alacrima in familial autonomic dysfunction. AMA Arch Ophthalmol. 1954;52(6):925–31.

    Article  CAS  PubMed  Google Scholar 

  11. Liebman SD. Ocular manifestations of Riley-Day syndrome: familial autonomic dysfunction. AMA Arch Ophthalmol. 1956;56(5):719–25.

    Article  CAS  PubMed  Google Scholar 

  12. Goldberg MF, Payne JW, Brunt PW. Ophthalmologic studies of familial dysautonomia: the Riley-Day syndrome. Arch Ophthalmol. 1968;80(6):732–43.

    Article  CAS  PubMed  Google Scholar 

  13. Riley CM, Moore RH. Familial dysautonomia differentiated from related disorders: case reports and discussions of current concepts. Pediatrics. 1966;37(3):435–46.

    CAS  PubMed  Google Scholar 

  14. Lutman F. Paroxysmal lacrimation when eating. Am J Ophthalmol. 1947;30(12):1583–5.

    Article  CAS  PubMed  Google Scholar 

  15. Jampel RS, Titone C. Congenital paradoxical gustatory-lacrimal reflex and lateral rectus paralysis: case report. Arch Ophthalmol. 1962;67(2):123–6.

    Article  CAS  PubMed  Google Scholar 

  16. Welham RA, Hughes SM. Lacrimal surgery in children. Am J Ophthalmol. 1985;99(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  17. Whitnall S. The lacrimal apparatus. In: The anatomy of the human orbit and accessory organs of vision. New York: Oxford University Press; 1921. p. 223–52.

    Google Scholar 

  18. Ali MJ. Disorders of the upper lacrimal system. In: Principles and practice of lacrimal surgery. Singapore: Springer; 2018. p. 133–46.

    Chapter  Google Scholar 

  19. Ali MJ, Mohapatra S, Mulay K, Naik MN, Honavar SG. Incomplete punctal canalisation: the external and internal punctal membranes. Outcomes of membranotomy and adjunctive procedures. Br J Ophthalmol. 2013;97(1):92–5.

    Article  PubMed  Google Scholar 

  20. Chaung JQ, Sundar G, Ali MJ. Congenital lacrimal fistula: a major review. Orbit. 2016;35(4):212–20.

    Article  PubMed  Google Scholar 

  21. Sullivan TJ, Clarke MP, Morin JD, Pashby RC. The surgical management of congenital lacrimal fistulae. Aust N Z J Ophthalmol. 1992;20(2):109–14.

    Article  CAS  PubMed  Google Scholar 

  22. Al-Salem K, Gibson A, Dolman PJ. Management of congenital lacrimal (anlage) fistula. Br J Ophthalmol. 2014;98(10):1435–6.

    Article  PubMed  Google Scholar 

  23. MacEwen C, Young J. Epiphora during the first year of life. Eye. 1991;5(5):596.

    Article  PubMed  Google Scholar 

  24. Sathiamoorthi S, Frank RD, Mohney BG. Incidence and clinical characteristics of congenital nasolacrimal duct obstruction. Br J Ophthalmol. 2018;103:527. https://doi.org/10.1136/bjophthalmol-2018-312074.

    Article  PubMed  Google Scholar 

  25. Kashkouli MB, Beigi B, Parvaresh M, Kassaee A, Tabatabaee Z. Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure? Br J Ophthalmol. 2003;87(9):1151–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Group PEDI. Primary treatment of nasolacrimal duct obstruction with probing in children younger than 4 years. Ophthalmology. 2008;115(3):577–84.e3.

    Article  Google Scholar 

  27. Vagge A, Ferro Desideri L, Nucci P, Serafino M, Giannaccare G, Lembo A, et al. Congenital nasolacrimal duct obstruction (CNLDO): a review. Diseases. 2018;6(4):96.

    Article  CAS  PubMed Central  Google Scholar 

  28. MacEwan CJ, Young JD. The fluorescein disappearance test (FDT): an evaluation of its use in infants. J Pediatr Ophthalmol Strabismus. 1991;28(6):302–5.

    Article  Google Scholar 

  29. Matta NS, Singman EL, Silbert DI. Prevalence of amblyopia risk factors in congenital nasolacrimal duct obstruction. J Am Assoc Pediatr Ophthalmol Strabismus. 2010;14(5):386–8.

    Article  Google Scholar 

  30. Matta NS, Silbert DI. High prevalence of amblyopia risk factors in preverbal children with nasolacrimal duct obstruction. J Am Assoc Pediatr Ophthalmol Strabismus. 2011;15(4):350–2.

    Article  Google Scholar 

  31. Petersen RA, Robb RM. The natural course of congenital obstruction of the nasolacrimal duct. J Pediatr Ophthalmol Strabismus. 1978;15(4):246–50.

    Article  CAS  PubMed  Google Scholar 

  32. Paul TO. Medical management of congenital nasolacrimal duct obstruction. J Pediatr Ophthalmol Strabismus. 1985;22(2):68–70.

    Article  PubMed  Google Scholar 

  33. Sathiamoorthi S, Frank RD, Mohney BG. Spontaneous resolution and timing of intervention in congenital nasolacrimal duct obstruction. JAMA Ophthalmol. 2018;136(11):1281–6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sathiamoorthi S, Frank R, Mohney BG. Rate of resolution in congenital nasolacrimal duct obstruction. J Am Assoc Pediatr Ophthalmol Strabismus. 2017;21(4):e12.

    Article  Google Scholar 

  35. Crigler LW. The treatment of congenital dacryocystitis. J Am Med Assoc. 1923;81(1):23–4.

    Article  Google Scholar 

  36. Kushner BJ. Congenital nasolacrimal system obstruction. Arch Ophthalmol. 1982;100(4):597–600.

    Article  CAS  PubMed  Google Scholar 

  37. Karti O, Karahan E, Acan D, Kusbeci T. The natural process of congenital nasolacrimal duct obstruction and effect of lacrimal sac massage. Int Ophthalmol. 2016;36(6):845–9.

    Article  PubMed  Google Scholar 

  38. Lee KA, Chandler DL, Repka MX, Beck RW, Foster NC, Frick KD, et al. A randomized trial comparing the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction. Arch Ophthalmol. 2012;130(12):1525.

    Article  PubMed Central  Google Scholar 

  39. Robb RM, editor. Surgical management of congenital obstruction of the lacrimal collecting system, Revised ed. Philadelphia: Williams and Wilkins; 2005.

    Google Scholar 

  40. Miller AM, Chandler DL, Repka MX, Hoover DL, Lee KA, Melia M, et al. Office probing for treatment of nasolacrimal duct obstruction in infants. J Am Assoc Pediatr Ophthalmol Strabismus. 2014;18(1):26–30.

    Article  Google Scholar 

  41. Albert DM, editor. Ophthalmic plastic surgery. Cambridge, MA: Blackwell Science; 1996.

    Google Scholar 

  42. Baker JD. Treatment of congenital nasolacrimal system obstruction. J Pediatr Ophthalmol Strabismus. 1985;22(1):34–5.

    Article  CAS  PubMed  Google Scholar 

  43. El-Mansoury J, Calhoun JH, Nelson LB, Harley RD. Results of late probing for congenital nasolacrimal duct obstruction. Ophthalmology. 1986;93(8):1052–4.

    Article  CAS  PubMed  Google Scholar 

  44. Robb RM. Success rates of nasolacrimal duct probing at time intervals after 1 year of age1. Ophthalmology. 1998;105(7):1307–10.

    Article  CAS  PubMed  Google Scholar 

  45. Katowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology. 1987;94(6):698–705.

    Article  CAS  PubMed  Google Scholar 

  46. Kushner BJ. The management of nasolacrimal duct obstruction in children between 18 months and 4 years old. J Am Assoc Pediatr Ophthalmol Strabismus. 1998;2(1):57–60.

    Article  CAS  Google Scholar 

  47. Honavar SG, Prakash VE, Rao GN. Outcome of probing for congenital nasolacrimal duct obstruction in older children. Am J Ophthalmol. 2000;130(1):42–8.

    Article  CAS  PubMed  Google Scholar 

  48. Rajabi MT, Abrishami Y, Hosseini SS, Tabatabaee SZ, Rajabi MB, Hurwitz JJ. Success rate of late primary probing in congenital nasolacrimal duct obstruction. J Pediatr Ophthalmol Strabismus. 2014;51(6):360–2.

    Article  PubMed  Google Scholar 

  49. Napier ML, Armstrong DJ, McLoone SF, McLoone EM. Congenital nasolacrimal duct obstruction: comparison of two different treatment algorithms. J Pediatr Ophthalmol Strabismus. 2016;53:285.

    Article  PubMed  Google Scholar 

  50. Young J, MacEwen C, Ogston S. Congenital nasolacrimal duct obstruction in the second year of life: a multicentre trial of management. Eye. 1996;10(4):485.

    Article  PubMed  Google Scholar 

  51. Schnall BM. Pediatric nasolacrimal duct obstruction. Curr Opin Ophthalmol. 2013;24(5):421–4.

    Article  PubMed  Google Scholar 

  52. Group PEDI. Repeat probing for treatment of persistent nasolacrimal duct obstruction. J Am Assoc Pediatr Ophthalmol Strabismus. 2009;13(3):306–7.

    Article  Google Scholar 

  53. Kraft SP, Crawford JS. Silicone tube intubation in disorders of the lacrimal system in children. Am J Ophthalmol. 1982;94(3):290–9.

    Article  CAS  PubMed  Google Scholar 

  54. Pe MRL, Langford JD, Linberg JV, Schwartz TL, Sondhi N. Ritleng intubation system for treatment of congenital nasolacrimal duct obstruction. Arch Ophthalmol. 1998;116(3):387–91.

    Article  CAS  PubMed  Google Scholar 

  55. Welsh MG, Katowitz JA. Timing of silastic tubing removal after intubation for congenital nasolacrimal duct obstruction. Ophthal Plast Reconstr Surg. 1989;5(1):43–8.

    Article  CAS  PubMed  Google Scholar 

  56. Lim CS, Martin F, Beckenham T, Cumming RG. Nasolacrimal duct obstruction in children: outcome of intubation. J Am Assoc Pediatr Ophthalmol Strabismus. 2004;8(5):466–72.

    Article  Google Scholar 

  57. Lin AE, Chang Y-C, Lin M-Y, Tam K-W, Shen Y-D. Comparison of treatment for congenital nasolacrimal duct obstruction: a systematic review and meta-analysis. Can J Ophthalmol. 2016;51(1):34–40.

    Article  PubMed  Google Scholar 

  58. Marr J, Drake-Lee A, Willshaw H. Management of childhood epiphora. Br J Ophthalmol. 2005;89(9): 1123–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Leone CR, Van Gemert JV. The success rate of silicone intubation in congenital lacrimal obstruction. Ophthalmic Surg Lasers Imag Retina. 1990;21(2): 90–2.

    Article  Google Scholar 

  60. Al-Hussain H, Nasr AM. Silastic intubation in congenital nasolacrimal duct obstruction: a study of 129 eyes. Ophthal Plast Reconstr Surg. 1993;9(1):32–7.

    Article  CAS  PubMed  Google Scholar 

  61. Eustis HS, Nguyen AH. The treatment of congenital nasolacrimal duct obstruction in children: a retrospective review. J Pediatr Ophthalmol Strabismus. 2018;55(1):65–7.

    Article  PubMed  Google Scholar 

  62. Lueder GT. Balloon catheter dilation for treatment of persistent nasolacrimal duct obstruction1. Am J Ophthalmol. 2002;133(3):337–40.

    Article  PubMed  Google Scholar 

  63. Tien DR, Young D. Balloon dilation of the nasolacrimal duct. J Am Assoc Pediatr Ophthalmol Strabismus. 2005;9(5):465–7.

    Article  Google Scholar 

  64. Repka M, Chandler D, Holmes J, Hoover D, Morse C, Schloff S, Paediatric Eye Disease Investigator Group, et al. Balloon catheter dilation and nasolacrimal duct intubation for treatment of nasolacrimal duct obstruction after failed probing. Arch Ophthalmol. 2009;127:633–9.

    Article  PubMed  Google Scholar 

  65. Wladis EJ, Aakalu VK, Yen MT, Bilyk JR, Sobel RK, Mawn LA. Balloon dacryoplasty for congenital nasolacrimal duct obstruction: a report by the American Academy of Ophthalmology. Ophthalmology. 2018;125:1654.

    Article  PubMed  Google Scholar 

  66. Ingels K, Kestelyn P, Meire F, Ingels G, Van Weissenbruch R. The endoscopic approach for congenital nasolacrimal duct obstruction. Clin Otolaryngol Allied Sci. 1997;22(2):96–9.

    Article  CAS  PubMed  Google Scholar 

  67. MacEwen C, Young J, Barras C, Ram B, White P. Value of nasal endoscopy and probing in the diagnosis and management of children with congenital epiphora. Br J Ophthalmol. 2001;85(3):314–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Gardiner JA, Forte V, Pashby RC, Levin AV. The role of nasal endoscopy in repeat pediatric nasolacrimal duct probings. J Am Assoc Pediatr Ophthalmol Strabismus. 2001;5(3):148–52.

    Article  CAS  Google Scholar 

  69. Lueder GT. Endoscopic treatment of intranasal abnormalities associated with nasolacrimal duct obstruction. J Am Assoc Pediatr Ophthalmol Strabismus. 2004;8(2):128–32.

    Article  Google Scholar 

  70. Nowinski TS, Flanagan JC, Mauriello J. Pediatric dacryocystorhinostomy. Arch Ophthalmol. 1985;103(8):1226–8.

    Article  CAS  PubMed  Google Scholar 

  71. Barnes EA, Abou-Rayyah Y, Rose GE. Pediatric dacryocystorhinostomy for nasolacrimal duct obstruction. Ophthalmology. 2001;108(9):1562–4.

    Article  CAS  PubMed  Google Scholar 

  72. Cunningham MJ, Woog JJ. Endonasal endoscopic dacryocystorhinostomy in children. Arch Otolaryngol–Head Neck Surg. 1998;124(3):328–33.

    Article  CAS  PubMed  Google Scholar 

  73. VanderVeen DK, Jones DT, Tan H, Petersen RA. Endoscopic dacryocystorhinostomy in children. J Am Assoc Pediatr Ophthalmol Strabismus. 2001;5(3): 143–7.

    Article  CAS  Google Scholar 

  74. Celenk F, Mumbuc S, Durucu C, Karatas ZA, Aytaç I, Baysal E, et al. Pediatric endonasal endoscopic dacryocystorhinostomy. Int J Pediatr Otorhinolaryngol. 2013;77(8):1259–62.

    Article  PubMed  Google Scholar 

  75. Bothra N, Wani RM, Ganguly A, Tripathy D, Rath S. Primary nonendoscopic endonasal versus external dacryocystorhinostomy in nasolacrimal duct obstruction in children. Indian J Ophthalmol. 2017;65(10):1004.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Bothra N, Naik MN, Ali MJ. Outcomes in pediatric powered endoscopic dacryocystorhinostomy: a single-center experience. Orbit. 2018;38:107–11.

    Article  PubMed  Google Scholar 

  77. Lueder GT. Neonatal dacryocystitis associated with nasolacrimal duct cysts. J Pediatr Ophthalmol Strabismus. 1995;32(2):102–6.

    Article  CAS  PubMed  Google Scholar 

  78. Edmond J, Keech RV. Congenital nasolacrimal sac mucocele associated with respiratory distress. J Pediatr Ophthalmol Strabismus. 1991;28(5):287–9.

    Article  CAS  PubMed  Google Scholar 

  79. Grin TR, Mertz JS, Stass-Isern M. Congenital nasolacrimal duct cysts in dacryocystocele. Ophthalmology. 1991;98(8):1238–42.

    Article  CAS  PubMed  Google Scholar 

  80. Rochon-Duvigneaud A. Dilatation of the tear ducts in the fetus and newborn following perforation of the inferior cavity: anatomical conditions which favor dacryocystitis. Arch Ophthalmol. 1899;19:81–9. Translation from the French by William P Boger III, MD.

    Google Scholar 

  81. Robb RM. Nasolacrimal duct obstruction in children. Focal Points. 2004;22:1–6. American Academy of Ophthalmology, San Francisco.

    Google Scholar 

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Robb, R.M., Aakalu, V.K. (2020). Lacrimal System Abnormalities. In: Albert, D., Miller, J., Azar, D., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-90495-5_276-1

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  • DOI: https://doi.org/10.1007/978-3-319-90495-5_276-1

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  • Print ISBN: 978-3-319-90495-5

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Chapter history

  1. Latest

    Lacrimal System Abnormalities
    Published:
    06 October 2021

    DOI: https://doi.org/10.1007/978-3-319-90495-5_276-2

  2. Original

    Lacrimal System Abnormalities
    Published:
    13 July 2020

    DOI: https://doi.org/10.1007/978-3-319-90495-5_276-1