Sáenz Araya David, Lizano Guevara Freddy, Sevilla Torres Enmanuel, Fernandez Vinocour Daniela, Rojas Peláez Alberto
General Medicine, Universidad de Ciencias Médicas (UCIMED), San José, CRI.
Cureus. 2025 Aug 22;17(8):e90754. doi: 10.7759/cureus.90754. eCollection 2025 Aug.
The lacrimal drainage system, or LDS, is an intricate anatomical and functional system that mobilizes and drains tears from the ocular surface into the nasal cavity. The drainage system first begins at the puncta, small openings located at the medial eyelids which actively funnel tears into the canaliculi. The canaliculi drain into the lacrimal sac (LS), with the LS residing in the lacrimal fossa, which collects the tear fluid and subsequently drains the fluid into the nasolacrimal duct (NLD), which empties into the inferior meatus of the nasal cavity. Variations in canalicular length and duct curvature and diameters influence the dynamics of tear flow in the LDS as well as the potential for obstruction. It should be noted that females appear to have narrower NLDs, which could contribute to the higher rates observed for nasolacrimal duct obstruction (NLDO). Importantly, the lacrimal pump mechanism activates during blinking by the Horner-Duverney part of the orbicularis oculi muscle on each side. There are valves in the LDS, like the valve of Rosenmüller, that allow unidirectional flow and prevent anterograde flow from the NLD into the inferior meatus nasal or pharyngeal region. An obstruction to the flow of tears out of the lacrimal drainage system could cause secondary changes in the lacrimal gland (LG), such as altered protein secretion properties, histologic remodeling in the LG, or altered migration of immune cells. The inflammatory and fibrotic processes involved in the progression of NLDO are likely mediated by T and B lymphocytes and fibrogenic cytokines that create fibroblasts which leads to progressive narrowing of the ductal lumen by various inflammatory and fibrotic processes such as lap-time would reveal. Anatomical influences related to NLDO include canalicular stenosis, dacryocystocele, deviated nasal septum (DNS), inferior turbinate hypertrophy (ITH), and sinus pathology. Diagnosis of NLDO is made through a clinical examination with imaging studies, including computed tomography (CT) or dacryocystography (DCG), and functional studies. Treatment includes conservative therapy, probing, balloon dacryoplasty, and dacryocystorhinostomy (DCR); outcomes are multifactorial, including etiology, age, and comorbidity.
泪液引流系统（LDS）是一个复杂的解剖和功能系统，它将眼表的泪液引流到鼻腔。该引流系统始于泪小点，即位于内侧眼睑的小孔，其主动将泪液导入泪小管。泪小管通向泪囊（LS），泪囊位于泪囊窝内，收集泪液并随后将其引流至鼻泪管（NLD），鼻泪管则排入鼻腔的下鼻道。泪小管长度、管道曲率和直径的变化会影响泪液引流系统中泪液流动的动力学以及阻塞的可能性。需要注意的是，女性的鼻泪管似乎更窄，这可能是鼻泪管阻塞（NLDO）发生率较高的原因。重要的是，泪泵机制在眨眼时由每侧眼轮匝肌的霍纳 - 迪韦尔尼部分激活。泪液引流系统中有瓣膜，如罗森米勒瓣膜，可实现单向流动并防止泪液从鼻泪管顺行流入下鼻道或咽部区域。泪液引流系统流出受阻可能会导致泪腺（LG）发生继发性变化，如蛋白质分泌特性改变、泪腺组织学重塑或免疫细胞迁移改变。NLDO进展过程中涉及的炎症和纤维化过程可能由T和B淋巴细胞以及促纤维化细胞因子介导，这些细胞因子产生成纤维细胞，导致管腔通过各种炎症和纤维化过程逐渐变窄，就像lap-time所显示的那样。与NLDO相关的解剖学影响包括泪小管狭窄、泪囊膨出、鼻中隔偏曲（DNS）、下鼻甲肥大（ITH）和鼻窦病变。NLDO的诊断通过临床检查并结合影像学检查，包括计算机断层扫描（CT）或泪囊造影（DCG）以及功能检查来进行。治疗包括保守治疗、探通、球囊泪道成形术和泪囊鼻腔吻合术（DCR）；治疗结果受多种因素影响，包括病因、年龄和合并症。
