Functional Nasolacrimal Duct Obstruction Leads to Excessive Tearing

Dacryocystitis (Photo By BSIP/UIG Via Getty Images)
Patients with nonanatomical functional delay experience a higher severity of epiphora than those with other nasolacrimal duct obstructions, a report shows.

Among patients with epiphora, those with nonanatomical functional delay (FNLDO) experience a high severity of epiphora, comparable with that of patients with nasolacrimal duct stenosis (NLDS) and those with complete nasolacrimal duct obstruction (NLDO), according to research published in Ophthalmic Plastic and Reconstructive Surgery.

Researchers conducted a retrospective review of consecutive adult patients with epiphora to determine whether the specific cause of nasolacrimal duct drainage impairment impacts the severity and symptoms of epiphora, visual tasks, and quality of life.

Patients were recruited from a tertiary lacrimal clinic between June 2011 and March 2021. Cases with identifiable causes of epiphora, such as evidence of canalicular stenosis, were excluded from the study. 

The researchers conducted a structured interview with patients to assess epiphora severity (Munk score), symptomatology, precipitating factors, effects on visual tasks, and QOL. They also evaluated the eyes of all patients with dacryocystography (DCG) and dacryoscintigraphy (DSG) following lacrimal syringing. The domains of the interview were compared between patients with NLDO, those with NLDS, and those with FNLDO.

A total of 122 symptomatic eyes of 63 patients (mean age, 63.3±17.2 years; 59% women and 41% men) were included in the study. The researchers found no difference in the mean epiphora Munk severity score between the groups (NLDO, 3.71 ± 0.18; NLDS, 3.79±2.0; FNLDO, 3.85 ± 0.15; P =.82). In all groups, most cases had a Munk severity score higher than 2 (NLDO, 86.8%; NLDS, 75.9%; FNLDO, 89.1%; P =.25).

The team reported that discharge was more common in patients with NLDO (65.7%) compared with those with NLDS (30.0%) and FNLDO (36.4%; P =.006). They also found that patients with FNLDO (77.1%) experience worsening in the cold and wind more frequently than patients with NLDO (48.5%; P =.029). They did not observe significant differences between the groups for visual tasks or quality of life.

“This study is the first to use clinical assessment and comprehensive lacrimal imaging (DCG and DSG) to differentiate symptomatology between functional and anatomical NLD obstruction,” according to the researchers. “The distinction between FNLDO and NLDS had little consequence on reported symptoms, precipitating factors, visual tasks, and QOL. Discharge may be more specific to NLDO, whereas precipitating cold or wind is more specific to FNLDO.”


Shapira Y, Macri C, Selva D. Functional versus anatomical nasolacrimal obstruction: are there differences in epiphora severity, symptoms, or effects on quality of life? Ophthalmic Plast Reconstr Surg. Published online May 3, 2022.  doi:10.1097/IOP.0000000000002208