Blocked tear duct
Definition:
When you have a blocked tear duct, your tears can't drain normally, leaving you with a watery, irritated eye. Blocked tear ducts are caused by a partial or complete obstruction in the tear drainage system.
As many as 20 percent of newborn babies have a blocked tear duct at birth, but it usually clears up on its own in the first year of life. Adults can get a blocked tear duct as a result of an infection, inflammation, an injury or a tumor. A blocked tear duct almost always is correctable, but the treatment depends on the cause and your age.
Symptoms:
Signs and symptoms may be caused by the blocked tear duct or from an infection that develops because of the blockage. Look for:
If your eye has been watery and leaking or is continually irritated or infected, make an appointment to see your doctor. Some blocked tear ducts are caused by tumors pressing on the tear drainage system, and quick identification of the tumor can give you more treatment options.
Causes:
Most of your tears come from your lacrimal glands, which are located above each eye. The tears flow down the surface of your eye to lubricate and protect it, and then drain into tiny holes (puncta) in the corners of your upper and lower eyelids. The tears then travel through the small canals in the lids (canaliculi) to a sac where the lids are attached to the side of the nose (lacrimal sac), then down a duct (the nasolacrimal duct) before emptying into your nose, where they evaporate or are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta to your nose. When that happens, your tears don't drain properly, giving you watery eyes and increasing your risk of eye infections and inflammation.
Blocked tear ducts can be present at birth (congenital) or can occur at any other age. Causes include:
Complications:
Because your tears aren't draining the way they should, the tears that remain in the drainage system become stagnant, promoting growth of bacteria, viruses and fungi. These organisms can lead to recurrent eye infections and inflammation. Any part of the tear drainage system, including the clear membrane over your eye surface (conjunctiva), can become infected or inflamed because of a blocked tear duct.
Treatments and drugs :
The cause of your blocked tear duct will determine which treatment is right for you. Sometimes, more than one treatment or procedure is needed before a blocked tear duct is completely corrected.
If an infection is suspected, your doctor will likely prescribe antibiotics.
If a tumor is causing your blocked tear duct, treatment will focus on the cause of the tumor. Surgery may be performed to remove the tumor, or your doctor may recommend using other treatments to shrink it.
Treatment options for non-tumor-blocked tear ducts vary from simple observation to surgery.
Conservative treatment
A high percentage of infants with congenital blocked tear duct improve on their own in the first several months of life, after the drainage system matures or the extra membrane involving the nasolacrimal duct opens up.
If your infant's blocked tear duct isn't opening on its own, your doctor may recommend that you use a special massage technique to help open up the membrane covering the lower opening into your baby's nose. Ask your doctor to show you how to perform this massage.
Conservative treatment may be recommended if the tear ducts become blocked from tissue swelling after facial injury. In most cases of blocked tear ducts after such facial trauma, the drainage system starts functioning again on its own a few months after the injury, and no further treatment is needed. Your doctor may recommend waiting three to six months after your injury before considering surgical intervention to open a blocked tear duct.
Minimally invasive treatment
Minimally invasive treatment options are used for infants and toddlers whose blocked tear ducts aren't opening on their own, or for adults who have a partially blocked duct or a partial narrowing of the puncta.
Surgery is usually the treatment of choice for adults and older children with acquired blocked tear ducts. It's also effective in infants and toddlers with congenital blocked tear ducts, though it's typically used after other treatments have been tried.
The surgery used to treat most cases of blocked tear ducts (called dacryocystorhinostomy) reconstructs the passageway for tears to drain out through your nose normally again. First, you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure. The surgeon accesses your tear drainage system, and then creates a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubation typically are placed in the new route while it heals, and then removed three or four months after surgery.
The steps in this procedure vary, depending on the exact location and extent of your blockage, as well as your surgeon's experience and preferences.
Definition:
When you have a blocked tear duct, your tears can't drain normally, leaving you with a watery, irritated eye. Blocked tear ducts are caused by a partial or complete obstruction in the tear drainage system.
As many as 20 percent of newborn babies have a blocked tear duct at birth, but it usually clears up on its own in the first year of life. Adults can get a blocked tear duct as a result of an infection, inflammation, an injury or a tumor. A blocked tear duct almost always is correctable, but the treatment depends on the cause and your age.
Symptoms:
Signs and symptoms may be caused by the blocked tear duct or from an infection that develops because of the blockage. Look for:
- Excessive tearing
- Watery eyes
- Recurrent eye inflammation (conjunctivitis)
- Recurrent eye infections (dacryocystitis)
- Painful swelling of the inside corner of the eye
- Eye mucus discharge
- Blurred vision
- Bloody tears
If your eye has been watery and leaking or is continually irritated or infected, make an appointment to see your doctor. Some blocked tear ducts are caused by tumors pressing on the tear drainage system, and quick identification of the tumor can give you more treatment options.
Causes:
Most of your tears come from your lacrimal glands, which are located above each eye. The tears flow down the surface of your eye to lubricate and protect it, and then drain into tiny holes (puncta) in the corners of your upper and lower eyelids. The tears then travel through the small canals in the lids (canaliculi) to a sac where the lids are attached to the side of the nose (lacrimal sac), then down a duct (the nasolacrimal duct) before emptying into your nose, where they evaporate or are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta to your nose. When that happens, your tears don't drain properly, giving you watery eyes and increasing your risk of eye infections and inflammation.
Blocked tear ducts can be present at birth (congenital) or can occur at any other age. Causes include:
- Congenital blockage. As many as 20 percent of all newborns have a blocked tear duct. In these instances, the tear drainage system may not be fully developed or there may be a duct abnormality. A thin tissue membrane often remains over the opening that empties into the nose (nasolacrimal duct) in congenitally blocked tear ducts. This usually opens spontaneously during the first or second month of life.
- Abnormal development of the skull and face (craniofacial abnormalities). The presence of craniofacial abnormalities, including those in certain disorders such as Down syndrome, increases the likelihood of blockage of the tear ducts.
- Age-related changes. Older adults may experience age-related changes that can cause blocked tear ducts, including narrowing of the punctal openings.
- Eye infections or inflammation. Chronic infections and inflammation of your eyes, tear drainage system or nose can cause your tear ducts to become blocked.
- Facial injuries or trauma. An injury to your face can cause bone damage near the drainage system and disrupt the normal flow of tears through the ducts.
- Tumors. Nasal, sinus or lacrimal sac tumors can occur along the tear drainage system, blocking it as they grow larger.
- Cysts or stones. Sometimes, cysts and stones form in the tear drainage system, creating blockages.
- Topical medications. Rarely, long-term use of certain topical medications, such as those that treat glaucoma, can cause a blocked tear duct.
- Other medications. A blocked tear duct is a possible side effect of docetaxel (Taxotere), a commonly used chemotherapy medication for breast or lung cancer.
Complications:
Because your tears aren't draining the way they should, the tears that remain in the drainage system become stagnant, promoting growth of bacteria, viruses and fungi. These organisms can lead to recurrent eye infections and inflammation. Any part of the tear drainage system, including the clear membrane over your eye surface (conjunctiva), can become infected or inflamed because of a blocked tear duct.
Treatments and drugs :
The cause of your blocked tear duct will determine which treatment is right for you. Sometimes, more than one treatment or procedure is needed before a blocked tear duct is completely corrected.
If an infection is suspected, your doctor will likely prescribe antibiotics.
If a tumor is causing your blocked tear duct, treatment will focus on the cause of the tumor. Surgery may be performed to remove the tumor, or your doctor may recommend using other treatments to shrink it.
Treatment options for non-tumor-blocked tear ducts vary from simple observation to surgery.
Conservative treatment
A high percentage of infants with congenital blocked tear duct improve on their own in the first several months of life, after the drainage system matures or the extra membrane involving the nasolacrimal duct opens up.
If your infant's blocked tear duct isn't opening on its own, your doctor may recommend that you use a special massage technique to help open up the membrane covering the lower opening into your baby's nose. Ask your doctor to show you how to perform this massage.
Conservative treatment may be recommended if the tear ducts become blocked from tissue swelling after facial injury. In most cases of blocked tear ducts after such facial trauma, the drainage system starts functioning again on its own a few months after the injury, and no further treatment is needed. Your doctor may recommend waiting three to six months after your injury before considering surgical intervention to open a blocked tear duct.
Minimally invasive treatment
Minimally invasive treatment options are used for infants and toddlers whose blocked tear ducts aren't opening on their own, or for adults who have a partially blocked duct or a partial narrowing of the puncta.
-
Dilation, probing and irrigation. This technique works
to open congenital blocked tear ducts in most infants. The procedure can
be done using general anesthesia or using a restraint in very young
babies. First, the doctor enlarges the punctal openings with a special
dilation instrument, and then a thin probe is inserted through the
puncta and into the tear drainage system. The doctor threads the probe
all the way out through the nasal opening, sometimes causing a popping
noise as the probe pierces through the extra membrane. The probe is
removed, and the tear drainage system is flushed with a saline solution
to clear out any remaining blockage.
For adults with partially narrowed puncta, a similar procedure is done in the doctor's office. The tear ducts are flushed and irrigated while the puncta are dilated. If the problem is related solely to a partial narrowing of the punctal opening, this procedure will often provide temporary relief, at least. Antibiotics may be prescribed for any infections. If irrigation and dilation doesn't work, or if the beneficial effects of the dilation are only temporary, surgery may be necessary to open narrowed puncta. Sometimes, a small incision at the punctal opening may be all that's necessary.
- Balloon catheter dilation. This procedure opens tear drainage passages that are narrowed or blocked by scarring, inflammation and other acquired conditions. While you're under general anesthesia, a tube (catheter) with a deflated balloon on the tip is threaded through the lower nasolacrimal duct in your nose. The doctor then uses a pump to inflate and deflate the balloon a few times, sometimes moving it to different locations along the drainage system. This procedure is more effective for infants and toddlers, but also may be used in adults with partial blockage.
- Stenting or intubation. In this procedure, tiny silicone or polyurethane tubes are used to open up blockages and narrowing within the tear drainage system. The procedure, which is usually done under general anesthesia, involves having a thin tube threaded through one or both puncta in the corner of your eye, all the way through the tear drainage system and out through your nose. After the insertion, a small loop of tubing remains visible at the corner of your eye, but it's not usually bothersome. These tubes are generally left in for three to four months, and then removed. Possible complications include inflammation from the presence of the tube.
Surgery is usually the treatment of choice for adults and older children with acquired blocked tear ducts. It's also effective in infants and toddlers with congenital blocked tear ducts, though it's typically used after other treatments have been tried.
The surgery used to treat most cases of blocked tear ducts (called dacryocystorhinostomy) reconstructs the passageway for tears to drain out through your nose normally again. First, you're given a general anesthetic, or a local anesthetic if it's performed as an outpatient procedure. The surgeon accesses your tear drainage system, and then creates a new, direct connection between your lacrimal sac and your nose. This new route bypasses the duct that empties into your nose (nasolacrimal duct), which is the most common site of blockage. Stents or intubation typically are placed in the new route while it heals, and then removed three or four months after surgery.
The steps in this procedure vary, depending on the exact location and extent of your blockage, as well as your surgeon's experience and preferences.
- External. An external dacryocystorhinostomy is a commonly used surgical method of opening a blocked tear duct. While you're under general anesthesia, your surgeon makes an incision on the side of your nose, near where the lacrimal sac is located. After connecting the lacrimal sac to your nasal cavity and placing a stent in the new passageway, the surgeon closes up the incision with a few stitches.
- Endoscopic or endonasal. The same bypass procedure can be performed using endoscopic instruments. Instead of making an incision, the surgeon uses a microscopic camera and other tiny instruments inserted through the nasal opening to your duct system. Sometimes, a fiber-optic light is inserted into your puncta to illuminate the surgical area. The benefits of this method are that there's no incision and no scar, and the recovery typically is faster and easier. The drawbacks are that it requires a surgeon with special training, and the success rates aren't as high as with the external procedure.
- Bypassing the entire lacrimal duct system. Depending on the type of blockage, your surgeon may recommend a reconstruction of your entire tear drainage system (called conjunctivodacryocystorhinostomy). Instead of creating a new channel from the lacrimal sac to your nose, the surgeon creates a new route from the inside corner of your eyes (puncta) to your nose, bypassing the tear drainage system altogether.
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