The nasolacrimal duct is a channel that connects the lacrimal sac, which is located in the upper part of the nose, to the conjunctival sac of the eye. The duct is responsible for draining tears away from the eye and into the nose. However, in some cases, cysts may form in the nasolacrimal duct, leading to various symptoms and complications. The different types of nasolacrimal duct cysts and their characteristics.
- Punctal cyst: A punctual cyst is a small cyst that forms in the opening of the nasolacrimal duct, known as the punctum. The punctum is located at the inner corner of the eye, and its main function is to drain tears into the nasolacrimal duct. Punctate cysts can cause tearing, discharge, and irritation of the eye. They are usually treated with surgical excision.
- Canalicular cyst: A canalicular cyst is a cyst that forms within the canalicular system of the nasolacrimal duct. The canalicular system consists of two small tubes that extend from the punctum to the lacrimal sac. Canalicular cysts can cause tearing, discharge, and swelling in the area of the punctum. They are usually treated with surgical excision.
- Lacrimal sac cyst: A lacrimal sac cyst is a cyst that forms within the lacrimal sac, which is located at the upper part of the nasolacrimal duct. The lacrimal sac is responsible for collecting tears from the canaliculi and draining them into the nasolacrimal duct. Lacrimal sac cysts can cause swelling and pain in the area of the sac, as well as tearing and discharge from the eye. They are usually treated with surgical excision.
- Nasolacrimal duct mucocele: A nasolacrimal duct mucocele is a cyst that forms within the nasolacrimal duct and is filled with mucus. Mucoceles can cause tearing, discharge, and swelling in the area of the duct. They are usually treated with surgical excision.
- Dacryocystocele: A dacryocystocele is a cyst that forms within the lacrimal sac and is caused by a blockage in the nasolacrimal duct. Dacryocystoceles can cause swelling and pain in the area of the sac, as well as tearing and discharge from the eye. They are usually treated with surgical excision.
- Primary acquired nasolacrimal duct obstruction: Primary acquired nasolacrimal duct obstruction (PANDO) is a condition in which the nasolacrimal duct becomes blocked, usually due to age-related changes or scarring. PANDO can cause tearing, discharge, and swelling in the area of the duct. It is usually treated with surgical intervention, such as dacryocystorhinostomy (DCR) or balloon dacryoplasty.
- Secondary acquired nasolacrimal duct obstruction: Secondary acquired nasolacrimal duct obstruction (SANDO) is a condition in which the nasolacrimal duct becomes blocked due to an underlying condition, such as trauma, infection, or inflammation. SANDO can cause tearing, discharge, and swelling in the area of the duct. Treatment depends on the underlying cause and may include antibiotics, anti-inflammatory medications, or surgery.
- Congenital nasolacrimal duct obstruction: Congenital nasolacrimal duct obstruction (CNLDO) is a condition in which the nasolacrimal duct fails to open at birth, leading to tearing and discharge from the eye. CNLDO usually resolves on its own within the first year.
Causes
There are several potential causes of nasolacrimal duct cysts, some of which are more common than others. In this article, we will discuss 20 possible causes of these cysts, including their symptoms and treatment options.
- Congenital abnormalities: A nasolacrimal duct cyst can develop due to a congenital abnormality in the nasolacrimal duct or tear sac. This may be due to an incomplete or absent canalization of the duct during fetal development, leading to the formation of a cyst.
- Blockage of the duct: A blockage in the nasolacrimal duct can cause a cyst to form. This blockage can be caused by various factors such as inflammation, infection, or anatomic abnormalities.
- Infections: Infections of the eye or surrounding tissues can lead to the formation of a nasolacrimal duct cyst. Bacterial or viral infections such as conjunctivitis or sinusitis can cause inflammation and blockage of the duct, leading to the formation of a cyst.
- Trauma: Trauma to the eye or surrounding structures can lead to the formation of a cyst. This can be due to a direct blow to the eye or facial area, or due to surgical trauma.
- Inflammatory disorders: Inflammatory disorders such as sarcoidosis or Wegener’s granulomatosis can cause inflammation and scarring of the nasolacrimal duct, leading to the formation of a cyst.
- Allergies: Allergic reactions can cause inflammation of the nasolacrimal duct and surrounding tissues, leading to the formation of a cyst.
- Tumors: Tumors in the nasolacrimal duct or surrounding structures can cause blockage and subsequent cyst formation. These tumors can be benign or malignant.
- Medications: Certain medications such as topical glaucoma medications or chemotherapy agents can cause inflammation or blockage of the nasolacrimal duct, leading to cyst formation.
- Radiation therapy: Radiation therapy for head and neck cancers can cause scarring and damage to the nasolacrimal duct, leading to cyst formation.
- Foreign bodies: Foreign bodies such as eyelashes or dirt can become lodged in the nasolacrimal duct, leading to inflammation and cyst formation.
- Nasal polyps: Nasal polyps are growths that can occur in the nasal cavity and can obstruct the nasolacrimal duct, leading to cyst formation.
- Systemic diseases: Systemic diseases such as diabetes or thyroid disorders can cause inflammation and scarring of the nasolacrimal duct, leading to cyst formation.
- Autoimmune diseases: Autoimmune diseases such as Sjogren’s syndrome or lupus can cause inflammation and damage to the nasolacrimal duct, leading to cyst formation.
- Aging: Aging can cause degeneration of the nasolacrimal duct, leading to blockage and cyst formation.
- Structural abnormalities: Structural abnormalities such as a deviated septum or nasal bone deformities can obstruct the nasolacrimal duct, leading to cyst formation.
- Cigarette smoking: Smoking can cause inflammation and damage to the nasolacrimal duct, leading to cyst formation.
- Hormonal changes: Hormonal changes such as those that occur during pregnancy or menopause can cause inflammation and blockage of the nasolacrimal duct, leading to cyst formation.
Symptoms
Common symptoms of nasolacrimal duct cysts, along with a detailed explanation of each symptom.
- Tearing: Excessive tearing is a common symptom of nasolacrimal duct cysts. The cyst can obstruct the normal flow of tears from the eye to the nose, leading to overflow of tears onto the cheeks.
- Discharge: Discharge from the eye can also occur due to nasolacrimal duct cysts. This discharge may be clear, cloudy or purulent.
- Epiphora: Epiphora is a medical term used to describe excessive tearing. It is a common symptom of nasolacrimal duct cysts.
- Irritation: Irritation of the eye is another common symptom of nasolacrimal duct cysts. The cyst can cause the eye to become red, itchy and swollen.
- Redness: Redness of the eye is another symptom that can occur due to nasolacrimal duct cysts. This can be due to irritation of the eye or due to infection.
- Swelling: Swelling of the eyelid is another symptom that can occur due to nasolacrimal duct cysts. This swelling may be mild or severe.
- Pain: Pain around the eye is a less common symptom of nasolacrimal duct cysts. This pain can be mild or severe.
- Sensitivity to light: Sensitivity to light is another symptom that can occur due to nasolacrimal duct cysts. The cyst can cause the eye to become more sensitive to light than normal.
- Blurred vision: Blurred vision is another symptom that can occur due to nasolacrimal duct cysts. This can be due to the pressure of the cyst on the eye.
- Diplopia: Diplopia is a medical term used to describe double vision. It can occur due to nasolacrimal duct cysts, especially if the cyst is large and pressing on the eye.
- Visual disturbance: Visual disturbance is another symptom that can occur due to nasolacrimal duct cysts. This can be due to the pressure of the cyst on the eye.
- Eye discharge: Eye discharge is another symptom that can occur due to nasolacrimal duct cysts. The discharge may be clear, cloudy or purulent.
- Nasal discharge: Nasal discharge is another symptom that can occur due to nasolacrimal duct cysts. This can be due to the blockage of the nasolacrimal duct by the cyst.
- Sinusitis: Sinusitis is an inflammation of the sinuses that can occur due to nasolacrimal duct cysts. This can be due to the blockage of the nasolacrimal duct by the cyst.
- Headache: Headache is another symptom that can occur due to nasolacrimal duct cysts. This can be due to the pressure of the cyst on the eye or due to sinusitis.
- Facial pain: Facial pain is another symptom that can occur due to nasolacrimal duct cysts. This can be due to the pressure of the cyst on the eye or due to sinusitis.
- Nasal obstruction: Nasal obstruction is another symptom that can occur due to nasolacrimal duct cysts. This can be due to the blockage of the nasolacrimal duct by the cyst.
Diagnosis
There are several diagnostic tests that can be used to confirm the presence of a nasolacrimal duct cyst and to determine the best course of treatment. Below are diagnostic tests that may be used in the diagnosis of nasolacrimal duct cysts, along with an explanation of how each test works and what it can tell us about the condition.
- Visual Examination: A visual examination of the eye and surrounding area may reveal the presence of a cyst or other abnormality in the nasolacrimal duct. The eye may appear swollen or red, and there may be discharge or crusting around the eyelids.
- Eye Ultrasound: An eye ultrasound is a non-invasive test that uses sound waves to create images of the eye and surrounding structures. This test can help to identify the presence of a cyst or other abnormality in the nasolacrimal duct.
- MRI: Magnetic resonance imaging (MRI) is a non-invasive test that uses magnetic fields and radio waves to create detailed images of the body. This test can help to identify the presence and location of a nasolacrimal duct cyst.
- CT Scan: A computed tomography (CT) scan is a non-invasive test that uses X-rays to create detailed images of the body. This test can help to identify the presence and location of a nasolacrimal duct cyst.
- Tear Duct Irrigation: Tear duct irrigation involves flushing the tear ducts with a saline solution to help identify any blockages or abnormalities in the nasolacrimal duct.
- Nasal Endoscopy: A nasal endoscopy is a minimally invasive test that involves inserting a thin, flexible tube with a camera into the nasal cavity to view the nasolacrimal duct and surrounding structures.
- Tear Film Breakup Time: Tear film breakup time (TBUT) is a test that measures how long it takes for the tear film on the surface of the eye to break up. A shorter TBUT can be an indicator of nasolacrimal duct dysfunction.
- Schirmer Test: The Schirmer test measures the number of tears produced by the eyes over a specified period of time. Reduced tear production can be an indicator of nasolacrimal duct dysfunction.
- Fluorescein Dye Test: The fluorescein dye test involves placing a special dye into the eye to help identify any blockages or abnormalities in the nasolacrimal duct.
- Jones Test: The Jones test involves placing a small amount of dye into the eye and then measuring the amount of dye that is present in the nose after a specified period of time. This test can help to identify any blockages or abnormalities in the nasolacrimal duct.
- Tear Meniscus Height Measurement: The tear meniscus height measurement is a test that measures the height of the tear film at the lower eyelid margin. A reduced tear meniscus height can be an indicator of nasolacrimal duct dysfunction.
- Conjunctival Swab: A conjunctival swab involves taking a sample of the conjunctival tissue to help identify any bacteria or other microorganisms that may be present.
- Biopsy: A biopsy involves taking a sample of tissue from the nasolacrimal duct or surrounding structures to help identify any abnormalities or cancerous cells.
Treatment
Medical treatments for nasolacrimal duct cysts:
- Observation and monitoring: In some cases, the cyst may not cause any symptoms or complications and may not require any treatment. The doctor may recommend observation and monitoring the cyst’s size and growth over time to determine if any intervention is necessary.
- Warm compresses: Applying warm compresses to the affected eye can help reduce inflammation and promote drainage of the cyst. The compress should be applied for 10-15 minutes several times a day.
- Antibiotics: If the cyst is infected, the doctor may prescribe antibiotics to treat the infection. Oral or topical antibiotics may be used depending on the severity of the infection.
- Topical steroids: Topical steroids can be used to reduce inflammation and swelling around the cyst. They are usually applied directly to the skin around the eye.
- Nasolacrimal duct massage: The doctor may perform a nasolacrimal duct massage to help the cyst drain. This technique involves applying pressure to the area around the tear duct to help the fluid flow out of the cyst.
- Saline irrigation: Saline irrigation involves flushing the nasolacrimal duct with a saline solution to help clear the duct and promote drainage of the cyst
Medications
Drugs that can be used to treat nasolacrimal duct cysts.
- Antibiotics: Antibiotics are often prescribed to treat nasolacrimal duct cysts that are caused by a bacterial infection. These drugs work by killing the bacteria that are causing the infection. Common antibiotics that may be prescribed for this purpose include amoxicillin, ciprofloxacin, and erythromycin.
- Steroids: Steroids are a type of anti-inflammatory medication that can help reduce the inflammation associated with nasolacrimal duct cysts. They can be given orally, topically, or as an injection. Common steroids that may be used to treat this condition include prednisone, dexamethasone, and triamcinolone.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are a type of painkiller that can also help reduce inflammation. They are often used to treat the pain and swelling associated with nasolacrimal duct cysts. Common NSAIDs that may be used for this purpose include ibuprofen, naproxen, and aspirin.
- Painkillers: Painkillers are medications that are used to relieve pain. They can be used to treat the pain associated with nasolacrimal duct cysts. Common painkillers that may be used for this purpose include acetaminophen and codeine.
- Topical Antihistamines: Topical antihistamines are medications that are applied directly to the skin or mucous membranes. They are often used to treat allergies, but can also be used to reduce inflammation and swelling. Common topical antihistamines that may be used to treat nasolacrimal duct cysts include diphenhydramine and azelastine.
- Topical Decongestants: Topical decongestants are medications that are applied directly to the nasal mucosa. They work by narrowing the blood vessels in the mucosa, which reduces swelling and inflammation. Common topical decongestants that may be used to treat nasolacrimal duct cysts include oxymetazoline and phenylephrine.
- Topical Steroids: Topical steroids are medications that are applied directly to the skin or mucous membranes. They work by reducing inflammation and swelling. Common topical steroids that may be used to treat nasolacrimal duct cysts include hydrocortisone and mometasone.
- Anticholinergics: Anticholinergics are medications that work by blocking the action of acetylcholine, a neurotransmitter that is involved in tear production. They can be used to reduce tear production in patients with nasolacrimal duct cysts. Common anticholinergics that may be used for this purpose include atropine and scopolamine.
- Beta Blockers: Beta blockers are medications that are used to treat high blood pressure, but can also be used to reduce tear production. They work by blocking the action of adrenaline, a hormone that is involved in tear production. Common beta blockers that may be used to treat nasolacrimal duct cysts include timolol and betaxolol.
Surgical treatments for nasolacrimal duct cysts:
- Dacryocystorhinostomy (DCR): DCR is a surgical procedure that involves creating a new drainage pathway for the tears to bypass the cyst. This is done by creating a new opening between the lacrimal sac and the nasal cavity.
- Endoscopic DCR: Endoscopic DCR is a minimally invasive version of the traditional DCR procedure. This procedure uses an endoscope to create a new drainage pathway without making any external incisions.
- External DCR: External DCR is the traditional surgical approach to treating nasolacrimal duct cysts. This procedure involves making an incision in the skin around the eye to access the lacrimal sac and create a new drainage pathway.
- Balloon dacryoplasty: Balloon dacryoplasty is a minimally invasive procedure that involves inflating a balloon inside the nasolacrimal duct to widen the duct and promote drainage of the cyst.
- Nasolacrimal intubation: Nasolacrimal intubation involves placing a stent or tube inside the nasolacrimal duct to help keep it open and promote drainage of the cyst.
- Laser dacryocystorhinostomy (DCR): Laser DCR is a variation of the traditional DCR procedure that uses a laser to create a new drainage pathway instead of making an incision with a scalpel.
- Laser-assisted balloon dacryoplasty: Laser-assisted balloon dacryoplasty combines the use of a laser with balloon dacryoplasty to widen the nasolacrimal duct and promote drainage of the cyst.
- Transcanalicular laser dacryocystorhinostomy (TCLDCR): TCLDCR is a minimally invasive laser procedure that involves creating a new drainage pathway through the puncta, which are the tiny openings in the eyelids
References
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