Paradigm Shifts in the Lacrimal Anatomy

  • Hirohiko Kakizaki


Anatomical knowledge in the lacrimal drainage system is rapidly advancing year by year. This topic would need a separate update, hence I picked up two representative topics which have been believed to be gold standard, but now needs to be revised based on the recent evidence and hence the need for a paradigm shift here! The first part of this chapter deals with valvular system and second with the medical canthal tendon.


Nasolacrimal Duct Posterior Limb Eyelid Margin Anterior Limb Medial Canthus 
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  1. 1.
    Aubaret E. The valves of the lacrymonasal passages. Arch Ophthalmol. 1908;28:211–36.Google Scholar
  2. 2.
    Whitnall SE. Anatomy of the human orbit and accessory organs of vision. 2nd ed. New York: Krieger Publishing Company; 1979. p. 241–3.Google Scholar
  3. 3.
    Kurihashi K. Ruido no kaibo. Ganka. 1996;38:301–13. Japanese.Google Scholar
  4. 4.
    Burkat CN, Lucarelli MJ. Anatomy of the lacrimal system. In: Cohen AJ, Brazzo B, editors. The lacrimal system: diagnosis, management, and surgery’. New York: Springer; 2006. p. 3–19.CrossRefGoogle Scholar
  5. 5.
    Katowitz JA, Hollsten DA. Silicone intubation of the nasolacrimal drainage system. In: Linberg JV, editor. Lacrimal surgery. New York: Churchill-Livingstone; 1988. p. 109–23.Google Scholar
  6. 6.
    Zoumalan CI, Joseph JM, Lelli Jr GJ, et al. Evaluation of the canalicular entrance into the lacrimal sac: an anatomical study. Ophthal Plast Reconstr Surg. 2011;27:298–303.PubMedCrossRefGoogle Scholar
  7. 7.
    Kurihashi K, Imada M, Yamashita A. Anatomical analysis of the human lacrimal drainage pathway under an operating microscope. Int Ophthalmol. 1991;15:411–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Kakizaki H, Zako M, Miyaishi O, et al. The lacrimal canaliculus and sac bordered by the Horner's muscle form the functional lacrimal drainage system. Ophthalmology. 2005;112:710–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Thale A, Paulsen F, Rochels R, et al. Functional anatomy of the human efferent tear ducts: a new theory of tear outflow mechanism. Graefes Arch Clin Exp Ophthalmol. 1998;236:674–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Paulsen FP, Thale A, Hallmann UJ, et al. The cavernous body of the human efferent tear ducts: function in tear outflow mechanism. Invest Ophthalmol Vis Sci. 2000;41:965–70.PubMedGoogle Scholar
  11. 11.
    Knight B. The pathophysiology of death. In: Knight B, editor. Forensic pathology. 2nd ed. London: Arnold Publisher; 1996. p. 52–4.Google Scholar
  12. 12.
    Cowen D, Hurwitz JJ. Anatomy of the lacrimal drainage system. In: Hurwitz JJ, editor. The lacrimal system. Philadelphia: Lippincott-Raven; 1996. p. 15–21.Google Scholar
  13. 13.
    Bailey JH. Surgical anatomy of the lacrimal sac. Am J Ophthalmol. 1923;6:665–71.CrossRefGoogle Scholar
  14. 14.
    Onogi J. Nasal endoscopic findings of functional obstruction of nasolacrimal duct. Rinsho Ganka. 2012;55:650–4. Japanese.Google Scholar
  15. 15.
    Kang H, Takahashi Y, Nakano T, et al. Medial canthal support structures–the medial retinaculum: a review. Ann Plast Surg. 2014 (Epub, in press).Google Scholar
  16. 16.
    Yamamoto H, Motikawa K, Uchinuma E, Tamashita S. An anatomical study of the medial canthus using a three-dimensional model. Aesthetic Plast Surg. 2001;25:189–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Jones LT, Wobig JL. Newer concepts of tear duct and eyelid anatomy and treatment. Trans Am Acad Ophthalmol Otolaryngol. 1977;83:603–16.Google Scholar
  18. 18.
    Ritleng P, Bourgeon A, Richelme H. New concepts of the anatomy of the lacrimal apparatus. Anat Clin. 1983;5:29–34.CrossRefGoogle Scholar
  19. 19.
    Fernandez-Valencia R, Gomez Pellico L. Functional anatomy of the human saccus lacrimaris. Acta Anat. 1990;139:54–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Couly G, Hureau J, Tessier P. The anatomy of the external palpebral ligament in man. J Maxillofac Surg. 1976;4:195–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Jones LT. Epiphora. Its relation to the anatomic structures and surgery of the medial canthal region. Am J Ophthalmol. 1957;43:203–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Adenis JP, Longueville E. Horner’s muscle placation using an anterior approach. Orbit. 1991;10:187–91.CrossRefGoogle Scholar
  23. 23.
    Kakizaki H, Zako M, Mito H, et al. The medial canthal tendon is composed of anterior and posterior lobes in Japanese eyes and fixes the eyelid complementarily with Horner’s muscle. Jpn J Ophthalmol. 2004;48:493–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Kakizaki H, Zako M, Nakano T, et al. Direct insertion of the medial rectus capsulopalpebral fascia to the tarsus. Ophthal Plast Reconstr Surg. 2008;24:126–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Wolff E. Wolff’s anatomy of the eye and orbit. 7th ed. Philadelphia: Saunders; 1976. p. 190.Google Scholar
  26. 26.
    Anderson RL. Medial canthal tendon branches out. Arch Ophthalmol. 1977;95:2051–2.PubMedCrossRefGoogle Scholar
  27. 27.
    Ahl NC, Hill JC. Horner’s muscle and the lacrimal system. Arch Ophthalmol. 1982;100:488–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Zide BM. Anatomy of the eyelid. Clin Plast Surg. 1981;8:623–34.PubMedGoogle Scholar
  29. 29.
    Shinohara H, Taniguchi Y, Kominami R, et al. The lacrimal fascia redefined. Clin Anat. 2001;6:401–5.CrossRefGoogle Scholar
  30. 30.
    Kakizaki H, Takahashi Y, Nakano T, et al. The posterior limb in the medial canthal tendon in Asians: dose it exist? Am J Ophthalmol. 2010;150:741–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Poh E, Kakizaki H, Selva D, et al. The anatomy of medial canthal tendon in Caucasians. Clin Experiment Ophthalmol. 2012;40:170–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Jones LT. The cure of epiphora due to canalicular disorders, trauma and surgical failures on the lacrimal passage. Trans Am Acad Ophthalmol Otolaryngol. 1962;66:506–24.PubMedGoogle Scholar
  33. 33.
    Kakizaki H, Selva D, et al. Dynamic study of the medial and lateral recti capsulopalpebral fasciae using cine mode magnetic resonance imaging. Ophthalmology. 2010;117:388–91.PubMedCrossRefGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Department of OphthalmologyAichi Medical UniversityAichiJapan

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