ABSTRACT
The history taking should be tailored to the patient’s age, bearing in mind the common causes of epiphora in each age group:
° congenital nasolacrimal duct obstruction ° congenital anomalies of the lacrimal drainage system
° trauma-canalicular/lacrimal sac lacerations, nasoethmoidal fractures
° canalicular scarring-herpes simplex canaliculitis ● Middle-aged patients
° dacryoliths-actinomyces infection ° cicatricial disorders of the lower eyelid anterior lamella
° idiopathic primary acquired nasolacrimal duct obstruction
° involutional eyelid malpositions Dacryoliths (lacrimal sac stones) are found in 2% to 5% of
dacryocystorhinostomies. Dacryoliths consist of dried mucus, lipid, and inflammatory debris, and are more often seen in patients with chronic dacryocystitis. They can be seen as small soft flakes, multiple small stones, or they can form an entire cast of the lacrimal sac ( Fig. 20.2 ). They can sometime be seen as filling defects on dacryocystography.
