Involutional stenosis Involutional stenosis is probably the most common cause of<unk>  in older people. It affects women twice as frequently as men. Although the inciting event in this process is unknown, clinicopathologic study suggests that compression of the lumen of the<unk> <unk>  is caused by inflammatory infiltrates and edema. This may be the result of an unidentified infection or possibly an autoimmune disease. Dacryolith Dacryoliths or cast formation, within the lacrimal sac can also produce<unk>  of the<unk> <unk> . Sinus disease Sinus disease often occurs in conjunction with, and in other instances may contribute to the development of<unk> . Patients should be asked about previous sinus surgery, as the<unk> <unk>  is sometimes damaged when the maxillary sinus ostium is being enlarged anteriorly. Trauma Naso-orbital fractures may involve the<unk> <unk> . Early treatment by fracture reduction with stenting of the entire lacrimal drainage system should be considered. However, such injuries are often not recognized or are initially neglected as more serious injuries are managed. In such cases, late treatment of persistent epiphora usually requires dacryocystorhinostomy. Inflammatory disease Granulomatous disease, including sarcoidosis, granulomatosis with polyangiitis, and midline granuloma, may also lead to<unk> . Lacrimal plugs As with similar cases of canalicular<unk> , dislodged punctual and canalicular plugs can migrate to and occlude the<unk> <unk> . Neoplasm Neoplasm should be considered in any patient presenting with<unk> . In patients with atypical presentations, including younger age and male gender, further workup is appropriate. Bloody punctual discharge or lacrimal sac distension above the medial canthal tendon is also highly suggestive of neoplasm. Congenital Congenital<unk> , or dacryostenosis, occurs when the lacrimal<unk>  has failed to open at the time of birth, most often due to an imperforate membrane at the valve of Hasner. Around 6% of infants have congenital<unk> , or dacryostenosis, usually experiencing a persistent watery eye even when not crying. If a secondary infection occurs (Dacryocystitis), purulent (yellow / green) discharge may be present. Most cases resolve spontaneously, with antibiotics reserved only if conjunctivitis occurs. Lacrimal sac massage has been proposed as helping to open the<unk> , though this is not always successful. The aim of massage is to generate enough hydrostatic pressure (downward, toward the nose) to "pop" open any<unk> . Additional massage may then be performed up toward the lacrimal punctum, in order to express any infectious material out of the<unk>  sac. When discharge or crusting is present, the lids should be gently cleaned using cooled pre-boiled water or saline. Referral to an ophthalmologist is indicated if symptoms are still present at 12 months, or sooner if significant symptoms or recurrent infections occur.<unk> <unk>  probing may be performed in the office setting (usually from 4 to 8 months of age) or under general anesthesia in an operating room for older patients. The success rate of probing is higher for younger children. A silastic tube or stent may be employed along with probing to maintain tear<unk>  patency. A systematic review comparing immediate probing with deferred probing found that in children with unilateral<unk> , immediate probing resulted in a higher success rate of treatment compared to deferred probing.
Nasolacrimal duct obstruction
Lacrimal sac
Oculomotor nerve palsy
Persistent pupillary membrane
Orbital emphysema
Vitreous hemorrhage
Corneal ectatic disorders
Protruding ear