Tear Duct Obstructions
What Is a Tear Duct Obstruction?
Anyone, at any age, can have an obstruction that blocks his or her tear ducts. While it is more common in adults, blockages can occur in infants and children, as well.
Your eyes are covered with a continuous layer of tear film that forms a protective barrier. Tears have three layers: The inner mucus layer which is the foundation of the tear film, the middle aqueous layer which is mostly water plus salt and nutrients and the outer lipid layer, the oily layer that prevents evaporation. Each layer is produced by a different part of the eye, and all three must work cohesively to protect the eye. Every time you blink, excess tears are drained into small ducts located near your nose. Sometimes one of these tear ducts can become blocked and your tears are unable to properly drain. If the duct is blocked, your tears will spill over your lower eyelid, and run down your cheeks.
Tears flow from your eyes through the puncta, the small drains at the inner corner of your eyes, near your nose. From the puncta, tears flow through into the canaculi, small channels that connect the eyes to the nose. The canaculi flow into the lacrimal sacs that are next to the nose. These sacs finally drain through nasolacrimal duct in your nose. This integrated tear duct system is why your nose often runs if you are crying. Although a blockage often occurs at the puncta, the start of the drainage system, an obstruction can occur at any stage of this four-part system. Since tears are an essential part of healthy eyes and protect your vision, it is necessary to open any obstructions so that your tears can flow properly.
A baby can be born before his or her tear ducts are fully developed or a blockage can develop during infancy. In most cases, these problems will resolve themselves before the child reaches age 1.
As we grow older, many things can cause a tear duct to become blocked. Some common causes are polyps, inflammation, infection, and trauma. A broken nose is a common cause of an obstruction. In some cases, the blockage can be a side effect of certain medications. Although an infection can cause a blocked tear duct, a blocked tear duct from any cause can also lead to infection - infection that can become chronic if the obstruction isn’t removed. This is because bacteria can accumulate and grow in the stagnant tears that collect in the blocked duct.
How Are Tear Duct Obstructions Detected?
Before your tear duct obstruction can be treated, the underlying cause of the blockage must be identified. Your eye doctor will conduct a comprehensive eye exam that will also include:
- Visual acuity and refraction: Testing your vision in each eye
- External and slit lamp examination
- Tonometry: Measuring your intraocular pressure
- Dilated eye exam: A comprehensive examination of your eye and retina
- Ophthalmoscopy: Evaluating any optic nerve or retinal condition
By applying fluorescein drops to your eyes, he will be able to observe how your tears drain from your eye. Another test the doctor may perform is to irrigate your tear duct system with saline water to observe how the water drains. He may also conduct a physical examination of your nose and have imaging tests performed, such as an X-ray, to determine if a tumor or other obstruction is present.
How Are Tear Duct Obstructions Treated?
Treatment of the obstruction depends on the underlying cause. For infants, the tear duct can usually be opened by massaging the area between his or her eyes and nose several times a day. This may take a period weeks or months to successfully open the blocked drain. In the small percentage of children for whom this is not successful, the use of a probe, a small wire that is threaded through the system, usually under anesthesia, may permanently open the blocked duct. This is the treatment of choice in infants with chronic infections. However, in rare cases, surgical reconstruction of the drainage system may become necessary.
Normally, a tear duct obstruction is painless. However, the lacrimal sac can become infected, either causing the blockage or as a result of a blockage elsewhere in the system. This infection is called dacryocystitis and causes pain and tenderness at the inside corner of your eye, as well as excess tears. This infection can also cause redness and tenderness in the upper part of your cheek. If you are diagnosed with this infection, you will be treated with oral antibiotics and/or antibiotic eyedrops.
Our board certified ophthalmologist who has also done a fellowship in oculoplastic surgery, is able to offer other procedures if antibiotic treatment is insufficient to open your blocked duct and / or the blockage keeps recurring, or if the blockage is caused by other factors. These outpatient surgical procedures can be used to re-establish the drainage system. If the tear blockage is at the puncta, it could be easily opened by a simple office procedure.
In cases of true nasolacrimal duct blockage, dacryocystorhinostomy (DCR), the medical term for reconstructing your tear duct system would be needed. In this procedure, a new passage is created between the lacrimal sac and the nose. A small plastic tube or stent is placed in the passageway to keep it open and to prevent scarring. After several months, the stent can be removed during a routine office examination with little or no discomfort, usually without the need for any anesthesia.
Our oculoplastic surgeon performs some of these procedures in our plastic surgery suite. In certain situations, such as when general anesthesia is required for a DCR, the surgery may be performed at Beth Israel Deaconess Medical Center, Plymouth. During surgery, you will feel little or no discomfort.
On the day of treatment, a staff member will welcome you. The staff will help you prepare for your surgery by putting eye drops in your eye. You will be given a gown to wear over your street clothes during your actual surgery.
You may be given a relaxing sedative along with local anesthetic. An injection will also be given around the eye for comfort.
Immediately after the surgery, you will rest in a comfortable reclining chair. Your family members may then join you in reviewing your follow-up care and schedule. You may be given medication or eyedrops to prevent infection.
Your eye may appear to be slightly bruised and swollen following the surgery. However, this should not cause significant discomfort. Your surgeon will follow-up with you to monitor healing and check for signs of inflammation and infection.
Some potential complications from treatment include the risk of bleeding and infection, which can usually be successfully treated. Most patients with chronic tearing and / or infection from a tear duct obstruction believe that the benefits outweigh the risks.
Oculoplastic Specialist at Kadrmas Eye Care New England
Meet our oculoplastic surgeon who specializes in the treatment of eyelid diseases and disorders: