Lacrimal Sump Syndrome

Lacrimal sump syndrome is a cause of persistent tearing (epiphora) after a tear-duct bypass operation called dacryocystorhinostomy (DCR). In this problem, a pocket (“sump”) is left behind at the lower part of the lacrimal sac or the new opening is placed too high, so tears pool and stagnate instead of flowing smoothly into the nose. Patients keep tearing even though they have already had surgery. Surgeons may see this after both external and endoscopic (endonasal) DCRs. EyeWikiJAMA Network

Lacrimal sump syndrome is a tear-drainage problem that usually shows up after tear-duct bypass surgery (dacryocystorhinostomy, “DCR”). Instead of tears flowing smoothly from the eye into the nose, a left-over pocket (“sump”) of the lacrimal sac sits below the new surgical opening. Tears fall into that pocket and pool there, so they do not empty well—you keep watering (epiphora), and sometimes mucus or infection recurs. Doctors call this a functional failure: the opening may look “open” on irrigation, but the plumbing layout makes drainage poor. When recognized, fixing the anatomy—usually by enlarging the opening downward and fully “marsupializing” (opening up) the remaining sac—works well. EyeWikiPubMedCanadian Journal of OphthalmologyJAMA Network

Normally, the lacrimal sac is opened fully and joined to the nasal lining so tears fall directly into the nose. If the lower portion is not opened or is re-formed by healing, a dependent reservoir remains under the new hole. Tears fall into that reservoir, stall, and only overflow later—often with recurrent infections. This is exactly what doctors mean by a “sump.” EyeWikiAmerican Academy of Ophthalmology

“Watery eyes” can come from too many tears or poor drainage. When drainage is the issue, doctors call it epiphora. After a DCR, continued epiphora with an otherwise open system is a red flag for LSS (a structural cause of failure). Medscape

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Types

These “types” are not official names from a single textbook. They are practical patterns doctors actually see and describe in reports and case series:

1. Low-pocket (classic) sump – incomplete opening of the inferior sac and proximal nasolacrimal duct leaves a true dependent pool below the ostium. EyeWiki

2. High ostium sump – the new opening is placed too high on the sac, so tears still collect in the lower remnant. American Academy of Ophthalmology

3. Small osteotomy sump – the bony window made in DCR is too small or poorly positioned; dependent parts of the sac stay closed. Canadian Journal of Ophthalmology

4. Mucosal flap re-formation sump – healing re-creates a sac-like cavity by re-approximating cut mucosa, again leaving a pocket. EyeWiki

5. Adhesion (synechiae) sump – intranasal adhesions narrow or misdirect outflow so tears swirl into a residual pocket. EyeWiki

6. Granulation/stenosis-related sump – granulation tissue or internal ostium stenosis narrows the outflow and functionally recreates a reservoir. SpringerLink

7. Ethmoid-interposed sump – intervening ethmoid cells or bony anatomy block a full sac opening; a dependent recess persists. SpringerLink

8. Tube-related sump – a Jones tube or silicone stent retracts into the sac or sits wrongly, creating a blind pouch that collects tears and infects. PMC

9. Large-ostium paradoxical sump – rarely, even with a large intranasal ostium, a sump develops because the dependent sac is still not marsupialized. PubMed

10. Early-healing sump vs. late-failure sump – the pocket may show early (weeks–months) or late (years) after DCR, often when scarring or remnant tissue becomes clinically significant. Canadian Journal of Ophthalmology

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Causes

1. Inadequate removal of lower lacrimal bone – not enough bone is taken below the sac, so the lower sac cannot open and becomes a pool. American Academy of Ophthalmology

2. Osteotomy too small – the window into the nose is tiny, limiting exposure of the inferior sac. Tears collect instead of draining. Canadian Journal of Ophthalmology

3. Osteotomy too high – the window is higher than the sac’s lowest point; the dependent part remains closed and acts as a reservoir. American Academy of Ophthalmology

4. Incomplete sac marsupialization – the sac lining is not fully opened and joined to the nose, leaving a leftover pouch. EyeWiki

5. Poor flap positioning – mucosal flaps are not secured or slip, so cut edges heal back together and re-form a sac. EyeWiki

6. Intranasal adhesions (synechiae) – nasal surfaces stick together during healing and narrow the outflow path. EyeWiki

7. Granulation tissue – “lumpy” healing tissue grows near the ostium and blocks smooth flow, pushing tears into a remnant pocket. SpringerLink

8. Internal ostium stenosis – the inner opening made by the surgery shrinks over time; a sump develops below it. SpringerLink

9. Intervening ethmoid cells – small ethmoid air cells sit between sac and nose, limiting the inferior opening. SpringerLink

10. Sac diverticulum/remnant – part of the sac bulges or remains as a cul-de-sac after surgery; tears lodge there. JAMA Network

11. Malpositioned stent or Jones tube – hardware sits inside the sac rather than into the nose, creating a blind cavity. PMC

12. Stent retraction – a tube or stent slides backward into the sac during healing; tears collect around it. PMC

13. Scar contraction – as the area heals and tightens, the lower sac becomes relatively “closed” again. Canadian Journal of Ophthalmology

14. Infection-driven edema – swelling from recurrent dacryocystitis narrows the ostium, favoring pooling below. PubMed

15. Wrong surgical plane – the surgeon did not fully expose the inferior sac and proximal duct, leaving dependent tissue closed. EyeWiki

16. Thick medial sac wall – a bulky sac wall can be hard to open completely, especially down low. (Inferred mechanism seen in surgical reviews of failed DCR.) SpringerLink

17. Septal deviation/turbinate crowding – tight nasal space can distort or block the new pathway, encouraging stasis. (Common intranasal contributors discussed in DCR failure reviews.) SpringerLink

18. Mucocoele remnants/dacryoliths – leftover mucus cyst wall or a stone within the sac traps tears below the ostium. (Mechanism reported across lacrimal imaging reviews.) American Journal of Roentgenology

19. Poor surgical exposure (novice cases) – limited incision or poor visualization misses the dependent sac. EyeWiki

20. Healing that “re-creates” a sac – even when the initial opening looks fine, mucosa can heal together and re-form a pocket over time. EyeWiki

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Symptoms

1. Constant tearing (epiphora)—tears roll down the cheek most of the day.

2. Tearing worse when upright or outdoors—gravity and wind make overflow more obvious.

3. Fullness at the inner corner—a heavy or “wet” feeling over the sac area.

4. Sticky discharge—especially on waking; dried crust on lashes.

5. Recurrent infections—redness, pain, warmth over the sac (repeated dacryocystitis). PubMed

6. Pressure-induced reflux—gentle press over the sac may push mucus or pus back to the eye.

7. Foul smell—from trapped, infected secretions.

8. Blurred vision—tears film the cornea.

9. Skin irritation—sore, chapped skin from constant wetness.

10. Social/functional bother—embarrassment, needing tissues, trouble with makeup or contact lenses.

11. Intermittent pain—dull ache near the sac, worse during infections.

12. Red inner eye corner—from chronic wetness and rubbing.

13. Stringy mucus—with chronic stagnation.

14. Occasional nose discharge of dye—after clinic tests; patients sometimes notice colored tears/drainage during testing.

15. “I had DCR but still tear”—history of DCR with ongoing epiphora is the classic story. Canadian Journal of Ophthalmology

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Diagnostic tests

The goal is to prove tears are stalling in a dependent sac pocket and to show why—usually a high or small/poorly placed ostium, incomplete inferior sac opening, adhesions, or healing problems. No single test is perfect; doctors combine history, examination, syringing, endoscopy, and imaging.

A) Physical examination

1. History and symptom grading (e.g., Munk score)
   You describe how often tears run down your cheek, whether you need tissues, and what makes it worse. This quantifies the problem and documents failure after DCR. (Background on epiphora and function.) Medscape

2. Look at the tear meniscus
   Under the slit lamp, the doctor checks if the tear line along the lower lid is high, a simple sign of poor outflow.

3. Regurgitation on pressure over lacrimal sac (ROPLaS)
   Gentle press over the sac may push mucus back through the punctum—evidence of stasis/infection in a reservoir.

4. Eyelid and punctum check
   The lids must align and move normally to pump tears. Malposition or punctal problems can mimic or worsen tearing. (Context from epiphora work-ups.) Medscape

5. Anterior rhinoscopy or basic nasal exam
   A quick intranasal look for septal deviation, turbinate crowding, or crusts that can block the ostium path. (Common contributors listed among DCR failures.) SpringerLink

B) Manual tests (hands-on office procedures)

6. Fluorescein Dye Disappearance Test (FDDT)
   A drop of dye is placed in each eye. After 5 minutes, the doctor looks: if dye lingers, drainage is poor. It’s simple and widely used. American Academy of OphthalmologyMayo ClinicPubMed

7. Jones I test
   Dye is placed in the eye; a cotton swab near the inferior meatus (inside the nose) checks if dye arrives. If not, outflow is faulty—as in a sump. NCBIEyeWiki

8. Jones II test
   After a negative Jones I, the doctor irrigates saline through the punctum. If dye appears now, a functional delay (like a sump) is likely rather than a complete block. NCBIEyeWiki

9. Lacrimal irrigation (“syringing”) and probing
   With a tiny cannula, saline is injected through the punctum. Easy flow to nose suggests patency; reflux or hold-up suggests a problem. In LSS, irrigation may seem patent yet symptoms persist—another clue to a dependent pocket rather than a hard block. ResearchGatecsurgeries.com

10. Endoscopic nasal examination
    Using a thin scope in the nose, the surgeon sees the ostium directly: Is it too high? Too small? Are there adhesions? This is one of the most helpful tests for LSS. PubMed

11. Compression-and-watch test
    The clinician gently compresses the sac and watches the nose endoscopically: if mucus wells up from below the ostium or the inferior sac bulges, that supports a sump.

C) Laboratory and pathological tests

12. Swab/culture of discharge
    If there is infection, a culture identifies bacteria so the right antibiotic can be chosen while planning surgery. (General guidance in epiphora and NLDO care.) PMC

13. Cytology or pathology (selected cases)
    In chronic, unusual, or mass-like sac disease, a small tissue sample rules out rare tumors or specific inflammation that may worsen stasis. (Imaging reviews discuss space-occupying sac lesions.) American Journal of Roentgenology

14. Basic infection labs (when acutely ill)
    With acute dacryocystitis (fever, redness), basic inflammatory labs support treatment decisions—but they do not diagnose LSS itself. PMC

D) Electrodiagnostic-style assessments

Important: There are no standard “electrodiagnostic” tests for LSS like the nerve tests used in neurology. A few research or adjacent physiologic tools are sometimes discussed:

15. Eyelid pump function assessment (EMG-aided in research)
    Surface EMG or high-speed recording can study the blink pump, helpful mainly in research on functional epiphora (not routine). (Context from physiologic studies of lacrimal outflow.) PMC

16. Rhinomanometry/acoustic rhinometry (adjacent)
    These measure nasal airflow/resistance with sensors. They don’t diagnose LSS, but can show nasal crowding that might contribute to ostium problems. (Adjunct to intranasal assessment mentioned in failure reviews.) SpringerLink

E) Imaging tests

17. Dacryocystography (X-ray/CT with contrast)
    Contrast is gently injected into the lacrimal system, then images show where fluid goes. In LSS you may see a dependent pocket below the ostium or delayed emptying despite an ostium. ScienceDirectAmerican Journal of Roentgenology

18. CT dacryocystography (CT-DCG)
    Modern CT-DCG (including multidetector/instillation techniques) provides crisp anatomy, shows high or small ostia, bone issues, and dependent gathering of contrast—very useful in planning revision surgery. PMCSpringerOpen

19. MR dacryocystography
    MRI-based lacrimal imaging avoids radiation and can show the sac, soft tissue, and surrounding nose. It helps in pre-op mapping when CT is less desirable. PMC

20. Lacrimal (radio)scintigraphy
    A tiny amount of tracer is dropped on the eye and a gamma camera tracks tear transit in a physiologic, low-pressure way. It is helpful for functional delays like a sump, although it has lower spatial detail than CT/MR. PMC+1Richtlijnendatabase

Non-pharmacological treatments

1. Education and watchful waiting (mild cases): if symptoms are light and stable, understanding the cause prevents over-treating; some patients adapt.
   Purpose/Mechanism: avoid unnecessary drugs; monitor for infection.

2. Warm compress + lid hygiene: soften crusts, improve lid margin health that can worsen tearing.
   Mechanism: heat and gentle cleaning reduce mucus and bacterial load.

3. Nasal saline irrigation or misting: keeps the ostium region clean and less crusted.
   Mechanism: humidified saline reduces scab formation at the opening.

4. Allergen avoidance and room humidification: cut down nasal mucosal swelling.
   Mechanism: fewer inflammatory triggers around the ostium.

5. Wind/sun protection (wrap-around glasses): reduces reflex tearing outdoors.
   Mechanism: less evaporation and irritation → fewer reflex tears.

6. Blink training and screen breaks: improves tear pumping and surface spread.
   Mechanism: frequent, full blinks thin the tear meniscus and reduce overflow.

7. Gentle sac expression during flares (not daily): brief, gentle pressure can clear mucus in the pocket.
   Mechanism: mechanical emptying of the “sump.”

8. Clinic-based lacrimal irrigation (saline flush): sometimes clears mucus plugs that exaggerate pooling.
   Mechanism: washes debris from the pocket and ostium.

9. Endoscopic debridement of crusts/granulation (office procedure): especially in the first 6–8 weeks after DCR.
   Mechanism: removes physical barriers that create a recess.

10. Silicone stent care and timely removal (if present): prevents tube-related pockets or lateral migration.
    Mechanism: avoids foreign-body niches that act like a sump.

11. Treat coexisting eyelid laxity or punctal eversion (non-surgical first): lubricants/taping at night for temporary support.
    Mechanism: improves lacrimal “pump” so tears don’t pool.

12. Smoking cessation: lowers chronic nasal inflammation.
    Mechanism: reduces mucosal edema around the ostium.

13. Manage chronic rhinitis triggers (dust masks at work, pet dander control):
    Mechanism: fewer flare-ups → steadier ostium function.

14. Nasal hygiene after URIs: gentle saline sprays during colds.
    Mechanism: limits post-infectious swelling and scabbing.

15. Cold compresses during acute swelling: symptom ease.
    Mechanism: vasoconstriction reduces local edema.

16. Skin care under the eye (barrier ointment for maceration): comfort and protection.
    Mechanism: shields skin from constant wetness.

17. Stop unnecessary redness “decongestant” eye drops: they can irritate and worsen tearing over time.
    Mechanism: avoids rebound hyperemia.

18. Optimize contact lens hygiene / limit wear in flares: fewer irritants → fewer reflex tears.
    Mechanism: calmer ocular surface.

19. Coordinate care with ENT for septum/spurs if relevant (planning stage): anatomic issues in the nose can be corrected if they matter.
    Mechanism: removes downstream barriers.

20. Plan timely definitive revision if symptoms persist: because LSS is an anatomic problem; conservative care is supportive only.
    Mechanism: surgery re-shapes the outflow to let gravity help, not fight you. PMC

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Drug options

Medicines do not fix the pocket, but they treat inflammation, allergy, infection, or tear over-production, which often reduce symptoms while you plan or recover from surgery. Doses below are typical adult dosing; your clinician will individualize.

1. Fluticasone intranasal spray (steroid; 50 mcg/actuation): 1–2 sprays/nostril once daily for 4–8 weeks.
   Purpose: shrink nasal/ostial mucosal swelling. Mechanism: local anti-inflammatory; improves patency around the ostium. Side effects: dryness, epistaxis. Medscape

2. Azelastine intranasal spray (antihistamine): 1–2 sprays/nostril twice daily during allergy seasons.
   Purpose/Mechanism: blocks histamine in nasal mucosa; reduces edema. Side effects: bitter taste, drowsiness.

3. Cetirizine (oral antihistamine 10 mg daily): as needed for allergic triggers.
   Purpose: reduce rhinorrhea/itching that worsens tearing. Side effects: sleepiness, dry mouth.

4. Amoxicillin-clavulanate (oral antibiotic, e.g., 875/125 mg twice daily for 7–10 days):
   Purpose: treat acute dacryocystitis or pre-revision infection. Mechanism: kills typical lacrimal sac pathogens. Side effects: GI upset, allergy (avoid in β-lactam allergy). Alternative regimens are used based on local resistance and allergies (e.g., doxycycline, TMP-SMX + metronidazole/clindamycin as guided).

5. Moxifloxacin 0.5% eye drops: 1 drop 3–4×/day for 7 days if conjunctivitis accompanies tearing.
   Purpose: topical bacterial coverage. Side effects: stinging; rare allergy.

6. Loteprednol 0.5% eye drops (short course steroid): 1 drop 3–4×/day for 1–2 weeks, only with doctor guidance.
   Purpose: settle ocular surface inflammation that amplifies tearing. Risks: IOP rise, cataract with prolonged use—monitoring is required.

7. Carboxymethylcellulose (artificial tears 0.5%): 1 drop 3–6×/day.
   Purpose/Mechanism: stabilizes surface, less reflex tearing from dryness; symptomatic only.

8. Hypertonic saline 5% ointment at night (if corneal edema/epithelial compromise):
   Purpose: improves morning blur/tearing from epithelial micro-edema. Note: niche use; clinician-directed.

9. Oxymetazoline nasal spray (short-term only): 1–2 sprays/nostril for ≤3 days during a severe cold.
   Purpose: quick decongestion around the ostium. Warning: use >3 days risks rebound congestion.

10. Botulinum toxin A injection into the lacrimal gland (procedure using a drug; typical 2.5–5 Units): relief lasts about 2–4 months; helpful when surgery is delayed or not possible.
    Purpose/Mechanism: temporarily reduces tear production from the lacrimal gland, lowering overflow into the sump. Common side effects: temporary ptosis or diplopia; usually mild and transient. Evidence supports benefit for functional and obstructive epiphora. PMC+2PMC+2EyeWiki

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Dietary & supportive supplements

No food or supplement removes a structural pocket, but smart choices can support nasal/ocular surface health, reduce inflammation, and improve comfort. Always discuss supplements with your clinician (drug interactions are possible).

1. Water (adequate hydration): target pale urine; supports tear film and mucus flow.

2. Omega-3 fatty acids (e.g., fish oil 1–2 g/day EPA+DHA): may help ocular surface comfort in some patients.

3. Vitamin A (≤2,500–3,000 IU/day unless told otherwise): supports surface epithelium; avoid high doses.

4. Vitamin C (500 mg/day): general collagen support and immune function.

5. Zinc (up to ~8–11 mg/day from diet or supplements if deficient): immune support; do not exceed chronic high doses.

6. Probiotics (lactobacillus/bifidobacterium, per label): gut-immune balance; may reduce upper-airway infections modestly.

7. Quercetin (250–500 mg/day): flavonoid with anti-allergy properties (may help rhinitis symptoms).

8. N-acetylcysteine (600 mg/day): mucus-modulating antioxidant; occasional off-label use for stringy mucus.

9. Turmeric/curcumin (500–1,000 mg/day standardized): anti-inflammatory; watch anticoagulant interactions.

10. Magnesium (200–400 mg/day): sleep/nerve support; choose glycinate or citrate.

11. Selenium (55 mcg/day from diet or supplement): antioxidant cofactor; avoid excess.

12. Elderberry or vitamin D (per local guidance if deficient): immune modulation.

13. Nasal saline xylitol sprays (per label): may reduce biofilm stickiness; symptomatic aid.

14. Green tea polyphenols (cup daily or extract 250 mg): mild anti-inflammatory.

15. Avoid megadoses and herbals that thin blood (e.g., ginkgo) right before surgery.

Evidence for supplements relates to surface comfort and general immune health, not to curing LSS, which remains a structural issue.

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Regenerative, and stem-cell drugs

There are no approved immune-boosting, regenerative, or stem-cell “drugs” that treat lacrimal sump syndrome. Experimental mesenchymal stem cell (MSC) approaches and lacrimal gland organoids are being studied mainly for severe dry eye due to lacrimal gland failure, not for outflow problems like LSS, and remain research-stage. U.S. regulators warn patients to be cautious about unapproved stem-cell treatments offered for eye diseases. If you see such offers for LSS, consider them unproven and potentially unsafe. SpringerLinkPMCCellU.S. Food and Drug Administration

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Surgeries

1. Revision endoscopic DCR with inferior extension + complete sac marsupialization
   What happens: the surgeon removes more inferior bone, opens the inferior sac wall fully, and fashions mucosal flaps so the sac floor opens directly into the nose.
   Why: it eliminates the pocket and lets gravity drain tears. High success when the sump is the main issue. PubMedAmerican Academy of Ophthalmology

2. Revision external DCR (skin approach) with low, wide ostium
   What happens: external route to precisely identify and open the entire sac and create a low anastomosis with nasal mucosa.
   Why: excellent exposure for tricky anatomy or scarring; success rates are high when anatomy is corrected. Medscape

3. Endoscopic marsupialization of the residual sac (“sump marsupialization”)
   What happens: targeted opening of the dependent sac remnant into the nose.
   Why: minimally invasive option when the rest of the DCR is good. PMC

4. Balloon-assisted endoscopic dacryoplasty (for selected failed DCRs)
   What happens: a balloon catheter dilates and reshapes the ostium; may be used with limited bone work.
   Why: less invasive; helpful in selected revision patterns with good outcomes in reports. SpringerLink

5. Conjunctivodacryocystorhinostomy (CDCR) with Jones tube (when canaliculi are not usable)
   What happens: a small glass tube creates a new path from the eye to the nose.
   Why: not for LSS alone, but used when canalicular disease coexists; tube position must be monitored to avoid new “sump-like” recesses. PMC

Key reality: LSS is usually straightforward to fix once recognized and the ostium is lowered and widened to include the inferior sac. EyeWiki

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Prevention tips

1. Plan a low, wide osteotomy that includes the inferior sac.

2. Fully marsupialize the sac—especially the posterior-inferior wall.

3. Use mucosal flaps to cover bone and keep the ostium shape stable.

4. Debride crusts early (endoscopic follow-up in the first 4–8 weeks).

5. Manage rhinitis/allergy (intranasal steroid/antihistamine when indicated).

6. Choose stenting judiciously and remove on time; check tube position.

7. Address septal deviation/spurs if they impinge on the ostium.

8. Educate patients about gentle nasal care and avoiding nose trauma early post-op.

9. Document ostium size; be aware that all ostia contract over time.

10. If watering persists despite “open” irrigation, think LSS and image/endoscope early—don’t wait months. NatureJAMA Network

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When to see a doctor

• Right away / urgent care if you have painful, red swelling at the inner corner, fever, worsening redness, or vision drop—these suggest dacryocystitis or cellulitis.

• Soon (within weeks) if you are still watering 6–12 weeks after DCR, or if watering returns months later.

• Anytime tearing disrupts work, driving, reading, or causes skin breakdown—effective treatments exist. Medscape

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What to eat—and what to avoid

Eat more of:
• Water (hydration), omega-3-rich fish, colorful vegetables/fruit, whole grains, yogurt/fermented foods, and lean proteins. These support general immune and mucosal health and may calm allergy/surface irritation.

Go easy on:
• Very salty foods (worsen nasal congestion/water retention in some people), alcohol (nasal vasodilation), spicy foods if they trigger rhinorrhea, smoke exposure, and supplement megadoses that thin blood right before surgery (fish oil >3 g/day, ginkgo, etc.).

Remember: diet can improve comfort but cannot remove a structural pocket.

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Frequently asked questions

1) Will medicines cure LSS?
No. They can ease symptoms (reduce swelling, infection, or tear production) but do not remove the pocket. Surgery is the definitive fix. EyeWiki

2) How common is tearing after a “successful” DCR?
About 5–10% continue to water despite an “open” ostium; LSS is one recognized cause. JAMA Network

3) How do doctors prove it’s LSS?
By endoscopy and contrast imaging (DCG/CT-DCG) that show a dependent sac remnant—the classic look. PMC

4) Can Botox help me avoid surgery?
Sometimes, yes—a lacrimal gland botulinum toxin A injection can temporarily reduce tearing for 2–4 months, useful if surgery is delayed or contraindicated. PMC+1

5) Is revision surgery hard?
Usually straightforward for experienced surgeons; the goal is to lower/widen the opening and eliminate the pocket. EyeWiki

6) Does ostium size matter long-term?
Yes—all ostia contract; a low, adequately wide ostium is linked to better functional success. JAMA NetworkScienceDirect

7) I was told my irrigation is “open.” Why am I still tearing?
That’s the hallmark of functional failure—fluid can pass with pressure, but normal blinking and gravity don’t clear the sump. PubMed

8) Could allergy or a cold make LSS feel worse?
Yes. Nasal swelling narrows the area around the ostium and worsens pooling; treating rhinitis often helps symptoms. Medscape

9) Is there any role for stem-cell or “regenerative” shots?
Not for LSS. Those are being studied mainly for dry eye, and none are approved for this condition. SpringerLinkU.S. Food and Drug Administration

10) What if I also have canalicular disease?
Your surgeon may consider CDCR (Jones tube) instead of—or after—revision DCR. Correct tube position is essential to avoid new sump-like recesses. PMC

11) How soon after DCR can LSS appear?
It can show early (from initial positioning) or late (from contracture or scarring). Canadian Journal of Ophthalmology

12) Does a bigger opening always prevent LSS?
Not always; even with a large ostium, shape and position matter. Rare cases report LSS despite a big opening. PubMed

13) Are there risks with Botox?
Yes—most commonly temporary droopy lid (ptosis) or double vision; effects wear off in weeks to months. PMC

14) What’s recovery like after revision?
Often day-surgery with nasal care (saline, gentle cleaning) and brief activity limits; your team will outline specifics.

15) How can I choose a good center for revision?
Look for surgeons who do endoscopic DCR regularly, can show you the ostium on endoscopy, and discuss inferior sac marsupialization as the target.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

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Last Updated: August 10, 2025.

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