Future Directions in Lacrimal Disorders and Their Management



“If we wish to make a new world we have the material ready. The first one, too, was made out of chaos”. This quote by Robert Quillen perhaps is applicable to lacrimal surgery at this point of time. The enormous explosion in the knowledge we had in the last decade and newer developments in terms of instrumentations, diagnostics, surgical techniques, and molecular biology techniques augurs well for the future of Dacryology. This chapter discusses some of the current trends and the possible future direction related to those trends. The ideas as to future directions are innumerous and the author has highlighted those that strike him. This list is by no means comprehensive or exhaustive and many more can be added.


Ocular Surface Molecular Biology Technique Pharmacological Blocker Basic Science Approach Lacrimal System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Paulsen FP, Thale AB, Maune S, et al. New insights into the pathophysiology of primary acquired dacryostenosis. Ophthalmology. 2001;108:2329–36.PubMedCrossRefGoogle Scholar
  2. 2.
    Liarakos VS, Boboridis KG, Mavrikakis E, et al. Management of canalicular obstructions. Curr Opin Ophthalmol. 2009;20:395–400.PubMedCrossRefGoogle Scholar
  3. 3.
    Chen D, Li N, Wan P, et al. A novel procedure to treat canalicular obstruction by recanaliculisation and bicanalicular intubation. Br J Ophthalmol. 2012;96:366–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Ali MJ, Naik MN. Efficacy of endoscopic guided anterograde 3 mm balloon dacryoplasty with silicone intubation in treatment of acquire partial nasolacrimal duct obstruction in adults. Saudi J Ophthalmol. 2014;28:40–3.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Chen D, Ge J, Wang L, Gao Q, et al. A simple and evolutional approach proven to recanalize the nasolacrimal duct obstruction. Br J Ophthalmol. 2009;93:1438–43.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Javate R, Pamintuan FG, Cruz RT, et al. Efficacy of endoscopic lacrimal duct recanalization using microendoscope. Ophthal Plast Reconstr Surg. 2010;26:330–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Feng YF, Yu JG, Shi JL, et al. A meta-analysis of primary external dacryocystorhinostomy with and without mitomycin C. Ophthalmic Epidemiol. 2012;19:364–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Ali MJ, Mariappan I, Maddileti S, et al. Mitomycin C in dacryocystorhinostomy: the search for the right concentration and duration–a fundamental study on human nasal mucosa fibroblasts. Ophthal Plast Reconstr Surg. 2013;29:469–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Feng YF, Cai JQ, Zhang JY, et al. A meta-analysis of primary dacryocystorhinostomy with and without silicone intubation. Can J Ophthalmol. 2011;46:521–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Knop E, Knop N. Lacrimal drainage-associated lymphoid tissue (LDALT): a part of the human mucosal immune system. Invest Ophthalmol Vis Sci. 2001;42:566–74.PubMedGoogle Scholar
  11. 11.
    Ali MJ, Mulay K, Pujari A, et al. Derangements of lacrimal drainage associated lymphoid tissue (LDALT) in human chronic dacryocystitis. Ocul Immunol Inflamm. 2013;21:417–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Kakizaki H, Takahashi Y, Sa HS, et al. Congenital dacryocystocele: comparative findings of dacryoendoscopy and histopathology in a patient. Ophthal Plast Reconstr Surg. 2012;28:e85–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Sasaki T, Nagata Y, Sugiyama K. Nasolacrimal duct obstruction classified by dacryoendoscopy and treated with inferior meatal dacryorhinotomy: Part II. Inferior meatal dacryorhinotomy. Am J Ophthalmol. 2005;140:1070–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Emmerich KH, Steinhauer J, Meyer-Rüsenberg HW, et al. Dacryoendoscopy–current status. Ophthalmologe. 1998;95:820–2.PubMedCrossRefGoogle Scholar
  15. 15.
    Ali MJ, Mohapatra S, Mulay K, et al. Incomplete punctal canalization: the external and internal punctal membranes. Outcomes of membranotomy and adjunctive procedures. Br J Ophthalmol. 2013;97:92–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Ali MJ, Naik MN. Canalicular wall dysgenesis: the clinical profile of canalicular hypoplasia and aplasia, associated systemic and lacrimal anomalies and clinical implications. Ophthal Plast Reconstr Surg. 2013;29:464–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Ali MJ, Motukupally SR, Joshi SD, Naik MN. The microbiological profile of lacrimal abscess: two decades of experience from a tertiary eye care center. J Ophthalmic Inflamm Infect. 2013;3:57–61.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Kaliki S, Ali MJ, Honavar SG, et al. Primary canaliculitis: clinical features, microbiological profile and management outcomes. Ophthal Plast Reconstr Surg. 2012;28:355–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Boase S, Foreman A, Cleland E, et al. The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection. BMC Infect Dis. 2013;13:210–8.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Ali MJ, Mishra DK, Baig F, et al. Punctal stenosis: histopathology, immunology and electron microscopic features. A step towards unraveling the mysterious etiopathogenesis. Ophthal Plast Reconstr Surg. 2014; (in press).Google Scholar
  21. 21.
    Ali MJ, Baig F, Lakshman M, et al. Electron microscopic features of nasal mucosa treated with topical and circumostial injection of mitomycin C (COS-MMC): implications in dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2014; (in press).Google Scholar
  22. 22.
    Kakizaki H, Ichinose A, Takahashi Y, et al. Anatomical relationship of Horner’s muscle origin and posterior lacrimal crest. Ophthal Plast Reconstr Surg. 2012;28:66–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Park J, Takahashi Y, Nakano T, et al. The orientation of the lacrimal fossa to the bony nasolacrimal canal: an anatomic study. Ophthal Plast Reconstr Surg. 2012;28:463–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Zoumalan CI, Joseph JM, Lelli GJ, et al. Evaluation of canalicular entrance into the lacrimal sac: an anatomical study. Ophthal Plast Reconstr Surg. 2011;27:298–303.PubMedCrossRefGoogle Scholar
  25. 25.
    Tiwari S, Ali MJ, Balla MM, et al. Establishing human lacrimal gland cultures with secretory function. PLoS One. 2012;7:e29458.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Ho A, Sachidananda R, Carrie S, et al. Quality of life assessment after non-laser endonasal dacryocystorhinostomy. Clin Otolaryngol. 2006;31:399–403.PubMedCrossRefGoogle Scholar
  27. 27.
    Smirnov G, Tuomilehto H, Kokki H, et al. Symptom score questionnaire for nasolacrimal duct obstruction in adults – a novel tool to assess the outcomes after endoscopic dacryocystorhinostomy. Rhinology. 2010;48:446–51.PubMedGoogle Scholar
  28. 28.
    Mistry N, Rockley TJ, Reynolds T, et al. Development and validation of a symptom questionnaire for recording outcomes in adult lacrimal surgery. Rhinology. 2011;49:538–45.PubMedGoogle Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  1. 1.Dacryology ServiceL.V. Prasad Eye InstituteBanjara Hills, HyderabadIndia

Personalised recommendations