Nasolacriminal dysfunction.

This investigation describes the normal function of the lacrimal drainage system of the eye. The intent of the presentation is to illustrate by clinical examples and pertinent literature, those alterations of normal function occurring from obstruction, trauma, or neoplasm. Sixty-nine patients with lacrimal dysfunction are included; 19 are offered in detail to illustrate principles of surgical management. It is not within the scope of this discussion to examine any condition which may cause primary hyperlacrimation or hypolacrimation, but to discuss: 1. the role of trauma as a cause of lacrimal drainage dysfunction. 2. the role of surgery in the prevention of lacrimal dysfunction, and 3. the role of surgery in the restoration of function. Among 18 patients with non-traumatic obstruction treated by silicone stenting, previous multiple dilatations treatment was associated with a higher rate of failure than in those patients not previously treated by multiple dilatations. Forty percent of 96 patients with facial fractures of the medial orbit had obstructive nasolacrimal symptoms; 79% of the 96 patients' symptoms cleared spontaneously; 15% required treatment. No incidence of significant iatrogenic trauma (requiring surgical treatment) was found in reviewing 1292 cases of rhinoplasty, rhinoseptoplasty, blepharoplasty, or sinus surgery. Normal function and physiology are reviewed. From the experiences of 69 patients emerge clinically proven methods of surgical management of lacrimal system obstruction. These methods are defined and then compared and contrasted to traditional methods and concepts. When there is disagreement or no consensus, alternate theories are discussed in attempting to explain those clinical conditions which seem to defy accepted principles. This presentation includes cases which have been managed by surgeons other than the author and who have been trained in fields other than otolaryngology. The cases offered in detail have been managed by the author.