Lacrimal Duct Obstruction
Lacrimal duct obstruction is caused by a partial or complete blockage of the tear duct, the thin channel (small tube) that normally drains tears from the eye’s surface and into the nose.
A blocked tear duct usually occurs when the drainage system between the inside corner of the eye and the inside of the nose is obstructed by something or does not properly open.
When either case happens, tears on the surface of the eyes are not allowed to move into the nose so that they can be reabsorbed into the body or evaporated into the air.
Consequently, the tear duct sac fills with tears. If not treated promptly, such a situation can lead to a watery, irritated eye that first becomes swollen and inflamed and, later, possibly infected.
The lacrimal glands, positioned above each eyeball, produce tears. The tears flow over the eye and then drain through the nasolacrimal ducts.
A small hole at the inside brink of each eyelid point to the opening of the ducts; it leads to the lacrimal sacs positioned on the side of the nose.
The tears go from the sacs into the nasolacrimal ducts and then into the nose. Once in the nose, they are either reabsorbed by the body or evaporated into the air.
When a tear duct gets obstructed, tears can spill over the eyelids and go down the face. Dormant tears in the system may become contaminated, leading to repeating red eyes as well as infections.
Extreme tearing can also produce secondary skin changes on the lower eyelids.
Increased risks for acquiring lacrimal duct obstruction include:
- premature birth
- age and gender (females being more at risk than males; as are older people over younger ones)
- chronic eye infections (dacryocystitis)
- family history of blocked tear ducts
- previous cancer treatments (chemotherapy or radiation), especially of the face or head
- abnormal bone growth or tumors around the eyes
- chronic eye inflammation (conjunctivitis)
- previous surgeries of the eye or eyelid, along with nasal or sinus surgery
- use of glaucoma medications
CAUSES AND SYMPTOMS
An inhibited tear duct may result in infection and also inflammation of the lacrimal sac. The space beneath the eyes next to the nose can become red, inflamed, and sensitive to the touch.
The area usually is swollen, painful, and there may be a mucous discharge from the opening of the nasal corner of the eye.
Blurred vision may also occur, along with bloody tears. Usual complaints include itching, irritation, burning, redness, foreign body sensation, and tearing.
Symptoms are worsened by cold weather, high winds, bright sunlight, and exposure to upper respiratory infections.
The initial symptom to appear is usually excessive tearing. It may occur as the appearance of wet-looking eyes or grow as large as excessive amounts of tears running down the cheeks.
Newborns have symptoms starting from a few days to a few weeks after being born. In all ages, symptoms include redness and inflammation around the eye or nose.
Yellow mucus may appear from the corners of the eye. Eventually, eyelids may stick together. Infection is usually a latter-stage symptom, especially in the eyelids.
Kids often have congenital lacrimal duct blockage. 6 to 10 percent of all children are born ahead their tear ducts are open.
The unopened tear duct is caused by immature tissue at the end of the tear duct, which causes it not to open normally.
Children may also acquire lacrimal duct obstruction due to infections, abnormal growth of the nasal bone, and undeveloped openings in the corners of the eyes.
In grown-ups, a common cause of lacrimal duct obstruction is involution, which is progressive degeneration happening naturally with advancing age, resulting in shriveling of organs or tissues.
Other causes include:
- eyelid disorders
- infections by bacteria, viruses, fungi, and parasites
- regular use of eye drops or excessive use of nasal spray
- topical medications that treat eye problems
- systemic chemotherapy
- trauma from previous surgeries to the bone at the side of the nose
- injuries to the face
- abnormal development of the skull and face
- foreign bodies
- sinus disease
- nasal polyps
- cysts and stones
- malignant or benign tumors
Smoking tobacco products can also increase the likelihood of tear blockages.
The medical professional will rely initially on the patient’s medical history and a physical examination.
If the main symptom is excessive tearing, the first step is for the healthcare professional to determine if the overflow of tears is due to increased tear production or a decrease in tear drainage.
Tests will establish the number of tears being produced and whether the tears are draining normally.
Such tests include the fluorescein dye disappearance (test for the ability of tears to drain), irrigation and probing (test for ability to drain and presence of blockage), and dacryocystography or dacryoscintigraphy (test to indicate the cause of blockage with use of medical scans).
Lacrimal duct obstructions in children usually resolve spontaneously, with 95% showing resolution before the child is one year old.
Daily massaging (two to four times each day) of the lacrimal sac can help open the blockage. A topical antibiotic ointment can be applied if the infection is present.
If the blockage is not resolved after several weeks to months of this therapy, a physician may attempt forceful irrigation.
Dilation, probing, and irrigation to open up the duct under general anesthesia or restraint is a last resort after six months to one year or so of more minor invasive treatments.
The dilation, probing, and irrigation technique is usually successful in most cases with children.
In adults, the condition is generally correctable, with conservative treatments usually recommended.
The cause of the blockage and a person’s age may make treatment more difficult. The infected or inflamed area can be massaged, with warm compresses applied to provide relief and speed the healing process.
The healthcare provider may also irritate the infected area. Topical antibiotic ointments and oral antibiotics are often applied to reduce infection.
Using analgesics such as aspirin may be recommended to control discomfort and reduce swelling.
Most adults respond positively to conservative treatments. If such approaches fail to clear the obstruction, surgical procedures are available, with success rates greater than 90%.
The vast majority of children outgrow the condition, and treatments are usually unnecessary. However, when treatments are necessary, they usually solve the problem.
Lacrimal duct obstruction is not preventable. In most cases, the cause of a lacrimal duct obstruction is unknown.
Most of the issues are congenital (present at birth). However, there are several effective ways to minimize the chances of having a blockage of the tear ducts.
For parents, if your child has a blockage of the tear ducts, keep the baby away from winds, sunlight, and coldness.
For adults, always treat sinus or eye infections promptly. When engaging in strenuous exercise and activities (such as bicycling) or contact sports (such as hockey)—when injuries to the face are likely—always wear a helmet or protective eye gear.
In addition, do not smoke tobacco products and do not abuse nasal sprays.
“Blocked Tear Ducts.” Mayo Clinic. http://www.mayoclinic.com/health/blocked-tear-duct/DS01096. (accessed December 9, 2019).
“Blocked Tear Ducts.” WebMD. http://www.webmd.com/eye-health/tc/blocked-tear-ducts-topic-overview. (accessed December 9, 2019).
“Nasolacrimal Duct Obstruction.” eMedicine. http://emedicine.medscape.com/article/1210141-overview (accessed December 9, 2019).
American Academy of Ophthalmology, P.O. Box 7424, San Francisco, CA 94120-7424, (415) 561-8500, (415) 561-8533, http://www.aao.org/.
American Optometric Association, 243 North Lindbergh Boulevard, St. Louis, MO 63141, (314) 991-4100, (800) 365-2219, http://www.aoanet.org.
National Eye Institute, 2020 Vision Place, Bethesda, MD 20892-3655, (301) 496-5248, http://www.nei.nih.gov/.