Long-term review of injuries to the lacrimal drainage apparatus.

A series of 57 patients with injuries to the proximal lacrimal drainage apparatus was reviewed to assess the long-term sequelae. The lower canaliculus was involved in 33 patients, the upper in ten, and both upper and lower in twelve, while the common canaliculus and lacrimal sac were each involved in one patient. It was found that either the upper or the lower canaliculus could cope independently with basal lacrimal secretions and that patients with at least one canaliculus intact had no symptoms under normal conditions. In seven patients with lower canalicular lacerations it was found that spontaneous functioning fistulae had developed nasal to the site of canalicular obstruction. The management of canalicular lacerations is discussed and it is recommended that the function of an intact canaliculus should not be jeopardized by surgical manipulations in an attempt to repair a damaged fellow canaliculus.