Acquired Tear Duct Stenosis (PANDO): A Patient Guide

Acquired tear duct stenosis, often referred to as Primary Acquired Nasolacrimal Duct Obstruction (PANDO), is a condition where the eye’s natural drainage system becomes physically blocked over time. Unlike the blockages some infants are born with, this version develops in adulthood, most frequently affecting women. It is a multifactorial condition that is thought to involve a cycle of chronic, low-grade inflammation in the lining of the tear duct. As this inflammation persists, it is often associated with fibrosis, a process where healthy tissue is replaced by scar tissue that slowly narrows and eventually obstructs the duct ^[1][2].

The hallmark of this condition is a persistent, overflowing tear, a symptom known as epiphora. Because the tears have no way to drain into the nose, they pool on the surface of the eye and spill over onto the cheek. This is often accompanied by a sticky or mucus-like discharge, as the fluid trapped within the tear sac becomes stagnant. While these symptoms are rarely a threat to your vision, they can be deeply frustrating, causing constant blurred vision, skin irritation, and social embarrassment ^[3][4]. Because epiphora can also be caused by dry eye, allergies, or eyelid issues, PANDO is a diagnosis made after careful examination.

In most adults with complete blockages, simple procedures like probing or flushing the duct are only temporary solutions, though they may be used for partial stenosis. Instead, the standard of care for complete obstruction is a surgical procedure called Dacryocystorhinostomy (DCR). This surgery creates a brand-new bypass channel that allows tears to drain directly from the eye into the nose, bypassing the blocked segment entirely. Whether performed through a small incision on the skin or internally through the nose, DCR is highly effective, with many patients finding relief from their symptoms, though individual success depends on anatomy and the specific cause ^[5][6].

While PANDO is generally a chronic and stable condition, it is important to stay vigilant for signs of infection. If the stagnant fluid in the tear sac becomes infected—a condition called acute dacryocystitis—it can cause sudden pain, redness, and a firm, tender swelling in the corner of the eye near the nose. This transition from a watery eye to a painful infection requires prompt medical attention to prevent the inflammation from spreading. For most, however, the path forward involves a clear diagnostic workup and a focus on restoring the natural flow of tears ^[7][8].