Pathogenesis of Primary Acquired Nasolacrimal Duct Obstruction

Purpose: To assess the factors assumed to be contributed in pathogenesis of primary acquired nasolacrimal duct obstruction (PANDO). Methods: In a prospective, controlled, interventional case series, 87 patients with symptomatic PANDO (case), 7 with traumatic nasolacrimal duct obstruction (NLDO) (control), 2 with congenital NLDO (control), and 70 asymptomatic females (control) were enrolled. Frequency of putting eye make-up (PANDO versus normal females), level of sexual hormones consisting of follicular stimulating hormone (FSH), luteal hormone (LH), estradiol, progesterone and testosterone (standard laboratory level), lacrimal sac biopsy for inflammation and fibrosis and immunohistochemistry for herpes simplex virus (HSV) type 1 and 2, and human papilloma virus were recorded. Results: Severity of inflammation and fibrosis were not significantly different between case and control groups (P = 0.69), and between smokers and nonsmokers with PANDO (P = 0.15). Patients with severe preoperative symptoms showed significantly more lacrimal sac fibrosis (P = 0.018). No lacrimal sac pathology was found. Frequency of putting eye make-up was not significantly different between case and control group (0.596). Immunohistochemistry was negative for the viruses in all cases. There was no abnormal sexual hormone level in any case in this series. Conclusion: This study did not find any evidence in favor of the role of viral infection (HSV1, HSV2, HPV), eye make-up, and sex hormones in pathogenesis of PANDO. No abnormal pathology was found in lacrimal sac biopsy of patients with PANDO.