Primary acquired nasolacrimal duct obstruction (PANDO)
Updates to Article Attributes
Primary acquired nasolacrimal duct obstruction or PANDO is a chronic inflammatory cause of nasolacremialnasolacrimal drainage apparatus obstruction.
Epidemiology
Most commonly seen in middle-aged or elderly women.
Pathology
Aetiology
ExactTHe exact cause is still not very well known however it thought to be due to the combination of inflammation, obstruction, and stasis factors. One recent study showed that Gram-negative organisms inin particular coagulase-negative staphylococciStaphylococci,nonspore-forming non spore forming anaerobeGram, gram-positive rods and Ppseudomonasseudomonas aeruginosa were frequently isolated but regardless of what the initial insult is, inflammation causes congestion and oedema worsen the narrowing of the passage. Congenitally
A congenitally narrow bony canal in some patients particularly(particularly in females) can contribute to this process. Stasis of teartears in lacrimal sac predisposes to further inflammation and infection. The more incidence of PANOPANDO in females has been attributed to narrower bony duct size and hormonal changes resulting in shedding of epithelial cells into the canal during menopause.
Location
PANDO manifests as gradual chronic inflammation and fibrosis along the entire length of the nasolacrimal duct initially more prominent at the sites of physiological narrowing such as the valve of Rosenmuller, the junction between the lacrimal sac and duct. Stenoses develop at symmetrical locations obon both sides but usually with lagging of stenosis in one side several years behind the other side so one-sided epiphora is still the most common presentation. The gradual obstruction leads into chronic dacryocystitis with several bouts of acute exacerbations.
Radiographic features
Imaging is not usually required for diagnosis or pre-treatment assessment. But CT scan is recommended after initial balloon dilatation and in recurrent cases.
Treatment and prognosis
Initially, any infection should be treated with appropriate antibiotics like Ciprofloxacinciprofloxacin then probing or balloon dacryocystoplasty which usually has a successful outcome. Finally, dacryocystorhinostomy can be performed (an opening is made surgically between the lacrimal sac and nasal cavity proximal to the obstruction).
-<p><strong>Primary acquired nasolacrimal duct obstruction</strong> or <strong>PANDO </strong>is a chronic inflammatory cause of <a title="Obstruction of nasolacrimal drainage apparatus" href="/articles/obstruction-of-nasolacrimal-drainage-apparatus">nasolacremial drainage apparatus obstruction</a><strong>. </strong></p><h4>Epidemiology </h4><p>Most commonly seen in middle-aged or elderly women.</p><h4>Pathology</h4><h5>Aetiology </h5><p>Exact cause is still not very well known however it thought to be due to the combination of inflammation, obstruction, and stasis factors. One recent study showed that Gram-negative organisms in particular <em>coagulase-negative staphylococci</em>, <em>nonspore</em><em>-forming anaerobe </em><em>Gram-positive rods</em> and <em>pseudomonas aeruginosa</em> were frequently isolated but regardless of what the initial insult is, inflammation causes congestion and oedema worsen the narrowing of the passage. Congenitally narrow bony canal in some patients particularly in females can contribute to this process. Stasis of tear in lacrimal sac predisposes to further inflammation and infection. The more incidence of PANO in females has been attributed to narrower bony duct size and hormonal changes resulting in shedding of epithelial cells into the canal during menopause. </p><h4>Location</h4><p>PANDO manifests as gradual chronic inflammation and fibrosis along the entire length of the nasolacrimal duct initially more prominent at the sites of physiological narrowing such as the <em>valve of Rosenmuller</em>, the junction between the lacrimal sac and duct. Stenoses develop at symmetrical locations ob both sides but usually with lagging of stenosis in one side several years behind the other side so one-sided epiphora is still the most common presentation. The gradual obstruction leads into chronic dacryocystitis with several bouts of acute exacerbations.</p><h4>Radiographic features</h4><p>Imaging is not usually required for diagnosis or pre-treatment assessment. But CT scan is recommended after initial balloon dilatation and in recurrent cases. </p><h4>Treatment </h4><p>Initially, any infection should be treated with appropriate antibiotics like Ciprofloxacin then probing or balloon dacryocystoplasty which usually has a successful outcome. Finally, dacryocystorhinostomy can be performed (an opening is made surgically between the lacrimal sac and nasal cavity proximal to the obstruction).</p><p> </p>- +<p><strong>Primary acquired nasolacrimal duct obstruction</strong> or <strong>PANDO </strong>is a chronic inflammatory cause of <a title="Obstruction of nasolacrimal drainage apparatus" href="/articles/obstruction-of-nasolacrimal-drainage-apparatus">nasolacrimal drainage apparatus obstruction</a><strong>. </strong></p><h4>Epidemiology </h4><p>Most commonly seen in middle-aged or elderly women.</p><h4>Pathology</h4><h5>Aetiology </h5><p>THe exact cause is still not very well known however it thought to be due to the combination of inflammation, obstruction, and stasis factors. One recent study showed that Gram-negative organisms in particular coagulase-negative <em>Staphylococci</em>, non spore forming anaerobe, gram-positive rods and P<em>seudomonas aeruginosa</em> were frequently isolated but regardless of what the initial insult is, inflammation causes congestion and oedema worsen the narrowing of the passage.</p><p>A congenitally narrow bony canal in some patients (particularly in females) can contribute to this process. Stasis of tears in lacrimal sac predisposes to further inflammation and infection. The more incidence of PANDO in females has been attributed to narrower bony duct size and hormonal changes resulting in shedding of epithelial cells into the canal during menopause. </p><h5>Location</h5><p>PANDO manifests as gradual chronic inflammation and fibrosis along the entire length of the nasolacrimal duct initially more prominent at the sites of physiological narrowing such as the valve of Rosenmuller, the junction between the lacrimal sac and duct. Stenoses develop at symmetrical locations on both sides but usually with lagging of stenosis in one side several years behind the other side so one-sided epiphora is still the most common presentation. The gradual obstruction leads into chronic dacryocystitis with several bouts of acute exacerbations.</p><h4>Radiographic features</h4><p>Imaging is not usually required for diagnosis or pre-treatment assessment. But CT scan is recommended after initial balloon dilatation and in recurrent cases. </p><h4>Treatment and prognosis</h4><p>Initially, any infection should be treated with appropriate antibiotics like ciprofloxacin then probing or balloon dacryocystoplasty which usually has a successful outcome. Finally, dacryocystorhinostomy can be performed (an opening is made surgically between the lacrimal sac and nasal cavity proximal to the obstruction).</p>