Canalicular Obstructions and Management

  • Moisés Enghelberg
  • Cat Nguyen BurkatEmail author


Canalicular stenosis or obstruction is a common cause of chronic epiphora. Proper evaluation of epiphora is the cornerstone of dacryology and will enable the practitioner to assess the underlying etiology, thus developing a sound surgical plan. The anatomical complexities of the lacrimal drainage system are discussed, as well as the proper technique and potential challenges in the diagnosis and management of this condition. Congenital and acquired causes of canalicular obstruction and canaliculitis are discussed. Iatrogenic canalicular obstruction may occur secondary to migrated or intracanalicular punctal plugs. In severe cases of canalicular obstruction, a conjunctivodacryocystorhinostomy may be necessary.


Congenital nasolacrimal duct obstruction Canalicular stenosis Silicone intubation Canalicular probing Congenital lacrimal fistula Canaliculitis Canaliculotomy Dacryolith Canaliculolith Dacryocystorhinostomy Conjunctivodacryocystorhinostomy 


  1. 1.
    Cohen AJ, Mercandetti M. The lacrimal system: diagnosis, management, and surgery. 2nd ed. New York: Springer; 2014. p. 49–53.Google Scholar
  2. 2.
    Kashkouli MB, Pakdel F, Kiavash V. Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system. Middle East Afr J Ophthalmol. 2012;19(1):60–9.CrossRefGoogle Scholar
  3. 3.
    Guzek JP, Ching AS, Hoang TA, et al. Clinical and radiologic lacrimal testing in patients with epiphora. Ophthalmology. 1997;104(11):1875–81.CrossRefGoogle Scholar
  4. 4.
    MacEwen CJ, Young JDH. Epiphora during the first year of life. Eye. 1991;5:596–600.CrossRefGoogle Scholar
  5. 5.
    Paul TO. Medical management of congenital nasolacrimal duct obstruction. J Pediatr Ophthalmol Strabismus. 1985;22:68–70.PubMedGoogle Scholar
  6. 6.
    Alañón Fernández MA, Alañón Fernández F, Martínez Fernández A, Cárdenas LM. Treatment of the congenital obstruction of the lachrymal duct, by means of balloon catheter, monocanalicular intubation, and endoscopic control. Acta Otorrinolaringol Esp. 2009;60(6):409–14.CrossRefGoogle Scholar
  7. 7.
    Galindo-Ferreiro A, Khandekar R, Akaishi PM, Cruz A, Gálvez-Ruiz A, Dolmetsch A, Schellini S. Success rates of endoscopic-assisted probing compared to conventional probing in children 48 months or older. Semin Ophthalmol. 2017;16:1–8.Google Scholar
  8. 8.
    Andalib D, Gharabaghi D, Nabai R, Abbaszadeh M. Monocanalicular versus bicanalicular silicone intubation for congenital nasolacrimal duct obstruction. J AAPOS. 2010;14(5):421–4. Scholar
  9. 9.
    Elsawaby EA, El Essawy RA, Abdelbaky SH, Ismail YM. Pushed monocanalicular intubation versus probing as a primary management for congenital nasolacrimal obstruction. Clin Ophthalmol. 2016;10:1487–93.CrossRefGoogle Scholar
  10. 10.
    Kaufman LM, Guay-Bhatia LA. Monocanalicular intubation with Monoka tubes for the treatment of congenital nasolacrimal duct obstruction. Ophthalmology. 1998;105(2):336–41.CrossRefGoogle Scholar
  11. 11.
    Jones LT, Wobig JL. Surgery of the eyelids and lacrimal system, vol. 67. Birmingham: Aesculapius Publishing Co.; 1976. p. 167–73.Google Scholar
  12. 12.
    Birchansky LD, Nerad JA, Kersten RD, Kulwin DR. Management of congenital lacrimal sac fistula. Arch Oph Thalmol. 1990;108:388–90.CrossRefGoogle Scholar
  13. 13.
    Levine J. Congenital fistula of the lacrimal sac. Am J Ophthalmol. 1929;12:745–6.CrossRefGoogle Scholar
  14. 14.
    Gupta S, Ali MJ, Naik MN. Lacrimal drainage anomalies in congenital rubella syndrome. Clin Ophthalmol. 2017;11:1975–7.CrossRefGoogle Scholar
  15. 15.
    Ganguly A, Ali MJ, Padmaja K, et al. Bacteremia following nasolacrimal duct probing: is there a role of pre-operative antibiotic prophylaxis? Ophthal Plast Reconstr Surg. 2016;32:90–2.CrossRefGoogle Scholar
  16. 16.
    Kijlstra A, Jeurissen SH, Koning KM. Lactoferrin levels in normal human tears. Br J Ophthalmol. 1983;67(3):199–202.CrossRefGoogle Scholar
  17. 17.
    Tung CI. Graft versus host disease: what should the oculoplastic surgeon know? Curr Opin Ophthalmol. 2017;28(5):499–504.CrossRefGoogle Scholar
  18. 18.
    Auran JD, Hornblass A, Gross ND. Stevens-Johnson syndrome with associated nasolacrimal duct obstruction treated with dacryocystorhinostomy and Crawford silicone tube insertion. Ophthal Plast Reconstr Surg. 1990;6(1):60–3.CrossRefGoogle Scholar
  19. 19.
    de Koning EW, van Bijsterveld OP. Herpes simplex virus canaliculitis. Acta Ophthalmol. 1983;186(4):173–6.CrossRefGoogle Scholar
  20. 20.
    Coster DJ, Welham RN. Herpetic canalicular obstructions. Br J Ophthalmol. 1979;65:259–62.CrossRefGoogle Scholar
  21. 21.
    Fulmer NL, Neal JG, Bussard GM, Edlich RF. Lacrimal canaliculitis. Am J Emerg Med. 1999;17:385–6.CrossRefGoogle Scholar
  22. 22.
    Repp DJ, Burkat CN, Lucarelli MJ. Lacrimal excretory system concretions: canalicular and lacrimal sac. Ophthalmology. 2009;116(11):2230–5.CrossRefGoogle Scholar
  23. 23.
    Esmaeli B, Valero V, Ahmadi MA, Booser D. Canalicular stenosis secondary to docetaxel (taxotere): a newly recognized side effect. Ophthalmology. 2001;108(5):994–5.CrossRefGoogle Scholar
  24. 24.
    Mansur C, Pfeiffer ML, Esmaeli B. Evaluation and management of chemotherapy-induced epiphora, punctal and canalicular stenosis, and nasolacrimal duct obstruction. Ophthal Plast Reconstr Surg. 2017;33(1):9–12.CrossRefGoogle Scholar
  25. 25.
    Fezza JP, Wesley RE, Klippenstein KA. The treatment of punctal and canalicular stenosis in patients on systemic 5-FU. Ophthalmic Surg Lasers. 1999;30(2):105–8.PubMedGoogle Scholar
  26. 26.
    Park J, Kim H. Sequential probing and dilatation in canalicular stenosis. Graefes Arch Clin Exp Ophthalmol. 2015;253(11):2007–13.CrossRefGoogle Scholar
  27. 27.
    Boulze-Pankert M, Roux C, Nkamga VD, Gouriet F, Rojat-Habib MC, Drancourt M, Hoffart L. Aggregatibacter aphrophilus chronic lacrimal canaliculitis: a case report. BMC Ophthalmol. 2016;16:132.CrossRefGoogle Scholar
  28. 28.
    Doucet TW, Hurwitz JJ. Canaliculodacryocystorhinostomy in the treatment of canalicular obstruction. Arch Ophthalmol. 1982;100(2):306–9.CrossRefGoogle Scholar
  29. 29.
    Steele EA. Conjunctivodacryocystorhinostomy with Jones tube: a history and update. Curr Opin Ophthalmol. 2016;27(5):439–42.CrossRefGoogle Scholar
  30. 30.
    Lim C, Martin P, Benger R, Kourt G, Ghabrial R. Lacrimal canalicular bypass surgery with the Lester Jones tube. Am J Ophthalmol. 2004;137(1):101–8.CrossRefGoogle Scholar
  31. 31.
    Rose GE, Richard WAN. Jones’ lacrimal canalicular bypass tubes: twenty five years’ experience. Eye. 1991;5:13–9.CrossRefGoogle Scholar
  32. 32.
    Bagdonaite L, Pearson AR. Twelve-year experience of Lester Jones tubes – results and comparison of 3 different tube types. Ophthal Plast Reconstr Surg. 2015;31(5):352–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyLarkin Community HospitalSouth MiamiUSA
  2. 2.Department of Ophthalmology and Visual SciencesUniversity of Wisconsin-MadisonMadisonUSA

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