Nasolacrimal Lavage as a Treatment for Ocular Surface Toxic Soup Syndrome (2025)

Summary

OSTSS leads to pooled inflammatory mediators in the tear film, causing symptoms like epiphora and discomfort. Here, we present a case where therapeutic nasolacrimal lavage every 2 months resolved epiphora and itchiness, suggesting its efficacy as a therapeutic intervention for OSTSS. Additionally, we report subjective improvements in symptoms in 3 additional patients.

Abstract

Ocular surface toxic soup syndrome (OSTSS) is characterized by inadequate tear drainage through the nasolacrimal duct system, leading to the accumulation of inflammatory mediators in the tear film. This condition can result in toxic keratoconjunctivitis, with symptoms such as conjunctival hyperemia, itchiness, discomfort, and epiphora. Dilation and irrigation are common diagnostic procedures in both optometry and ophthalmology, used to assess nasolacrimal duct obstruction in cases of epiphora. This technique involves the injection of saline into the nasolacrimal duct system through the puncta, followed by the evaluation of reflux, which indicates obstruction. Although intended to be diagnostic, many patients report significant improvements in epiphora and ocular comfort after the procedure. In this paper, we present a case study in which a patient achieved complete resolution of epiphora and itchiness following therapeutic nasolacrimal lavage performed every 2 months. Subjective improvements in symptoms in 3 additional patients are also reported. We propose nasolacrimal lavage not only as a diagnostic tool but also as an effective therapeutic intervention for managing OSTSS.

Introduction

Tear flow is essential for ocular surface homeostasis, maintained through interactions among the secretory and neurovascular systems, with the meibomian glands, lacrimal gland, goblet cells, conjunctiva, and their vascular and neural networks working together to sustain a stable tear film^1,2. This balance relies on the dynamic interplay between tear production and drainage, which directly affects the overall tear turnover rate (TTR)³. A reduced TTR can exacerbate dry eye symptoms by leading to the accumulation of inflammatory mediators on the ocular surface, resulting in what we term Oc

Protocol

Results

The patient (Patient 1) initially reported 100% improvement in nasal itchiness immediately following the procedure. At her 3-month follow-up, she reported remaining free of pruritus since the previous visit. Upon examination, bilateral inferior corneal staining, bulbar injection, and papilla had resolved. Four months later, the patient returned to the clinic with a recurrence of medial itchiness in both eyes. Her bilateral inferior corneal staining, bulbar injection, and papilla had reapp...

Discussion

Nasolacrimal lavage is a procedure designed to irrigate the nasolacrimal duct system, analogous to the use of a sinus rinse for the nasal passages. We hypothesize that it may remove allergens and inflammatory biomarkers from the tear drainage system, which could otherwise backflow onto the ocular surface. Additionally, nasolacrimal lavage aims to enhance tear turnover by clearing mucus or dacryoliths that may obstruct tear drainage. In essence, nasolacrimal lavage serves as an inverse to the commonly performed procedure ...

Disclosures

The authors have nothing to disclose.

Acknowledgements

We would like to express their sincere gratitude to the patient discussed in this case, who has since passed away. Her passing is deeply felt by both her family and the clinic staff. Throughout her treatment, her sincere appreciation during each nasolacrimal lavage not only inspired us to continue this procedure with other patients but also encouraged the writing of this manuscript. We hope that this manuscript serves as a small tribute to her memory.

Materials

References

Reprints and Permissions

Explore More Articles