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Real-time Venous Drainage of the Lacrimal Sac and the Nasolacrimal Duct

Ali, Mohammad Javed F.R.C.S.

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Ophthalmic Plastic and Reconstructive Surgery: July/August 2020 - Volume 36 - Issue 4 - p e107
doi: 10.1097/IOP.0000000000001480

A vascular plexus surrounding the lumen of the lacrimal sac and the nasolacrimal ducts was described by Henle in 1886. Detailed vasculature was studied by Paulsen, where they demonstrated the connection between this plexus and the cavernous bodies of the inferior turbinate. The post-capillary venules drain into large convoluted venous lacunae which subsequently drains into the veins near the bony surfaces. The current case with high magnification endoscopy images demonstrates the peri-sac and peri-nasolacrimal ducts venous plexus draining the blood from the walls of the lacrimal sac and nasolacrimal ducts (Fig. A,B). Note the changes in the vessel flow at the same location at two different time points (Fig. A,B, black arrows). The Supplemental Digital Content 1 (Video, available at http://links.lww.com/IOP/A206) demonstrates details of the flow in real-time. Understanding the venous flow through the plexus and cavernous bodies is crucial in understanding not only the lacrimal drainage physiology but also numerous lacrimal drainage disorders, the foremost among them being the pathogenesis of primary acquired nasolacrimal duct obstruction.

Lacrimal drainage venous flow. High magnification endoscopy image of the lacrimal sac and the nasolacrimal duct, showing vascular flow in the peri-sac and peri-NLD plexus (A and B). Also, note the changes in the flow (black arrows) in the same location at two different time points. NLD, nasolacrimal ducts.

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