Our eyes naturally produce tears to keep the surface wet, clear away dirt, and protect us from infection. Tears normally drain through tiny openings in the corners of the eyelids and into the tear ducts, which transport them to the nasal cavity. Tear duct obstruction, also known as nasolacrimal duct obstruction (NLDO), occurs when this drainage system becomes clogged or fails to function properly. This issue affects both children and adults, and if left untreated, it can cause discomfort, frequent eye infections, and visual impairments. Let’s take a look at what tear duct obstruction is, the common symptoms and concerns, the origins of the condition, and the treatment choices available to help you better manage any issues.
What is Tear Duct Obstruction?
Tear duct obstruction is caused by a blockage in the tear drainage system. This blockage stops tears from draining efficiently into the nose, causing them to accumulate in the eye. As a result, the patient has a constantly teary eye. Moreover, when tears and mucous stagnate in the tear sac, this can lead to inflammation, and predispose to infection.
There are two primary types of tear duct obstruction:
- Congenital (existing at birth): This occurs when the tear duct system does not fully develop or remains closed.
- Acquired (developed later in life): This is more common in adults and can be caused by infections, inflammation, injury, or ageing.
A blocked tear duct, regardless of its type, can have a substantial impact on one’s quality of life, especially if it causes persistent eye problems.
Common Symptoms and Potential Risks
The severity of tear duct obstruction symptoms varies according to the degree of blockage and whether or not an infection is involved. Here are the most commonly observed signs:
Common Symptoms:
- Excessive tearing (epiphora) even when not crying
- Persistent eye discharge, often sticky or mucous-like
- Crusting along the eyelashes
- Redness along the inner corner of the eyelids
- Recurrent eye infections such as conjunctivitis
- Swelling around the inner corner of the lower eyelid
- Blurred vision due to excessive tearing
Potential Risks:
If left untreated, tear duct obstruction can lead to:
- Chronic dacryocystitis – a painful infection of the tear sac that can become recurrent
- Abscess formation near the inner corner of the eye
- Spreading of infection to surrounding tissues and organs, such as the brain
- Scarring of the tear drainage system, making surgical correction more complex
- Impact on vision or overall eye health, especially in severe or long-standing cases
Although many tear duct obstructions in newborns resolve on their own, regular evaluation is necessary to avoid problems.
Causes of Tear Duct Blockage
Understanding the underlying cause of tear duct obstruction can help identify the ideal treatment option. Here are some of the most common causes:
1. Congenital Blockage
Some babies are born with an underdeveloped tear drainage system. Frequently, a thin membrane at the end of the tear duct fails to open at birth, causing blockage. This condition normally resolves with lacrimal massage and close monitoring during the first year of life, but if symptoms continue, treatment may be necessary.
2. Infections
Chronic or acute infections, particularly sinus infections and conjunctivitis, can cause swelling and scarring in the tear ducts. This inflammation can eventually scar up the drainage system and cause blockage.
3. Inflammatory disorders
Sarcoidosis, lupus, and Wegener’s granulomatosis are examples of inflammatory disorders that can harm the mucous membranes and cause tear duct obstruction. Allergies can also cause nasal passageways to become inflamed and narrowed.
4. Trauma
Facial trauma, nasal fractures, and nose and eye surgeries can harm the delicate tear duct system. Scarring and anatomical abnormalities can interfere with the regular flow of tears.
5. Age-Related Stenosis
By far the commonest cause of a blocked tear duct system is ageing. The bore of the tear ducts may narrow with age, otherwise known as stenosis. When tears and mucous cause chronic inflammation, the stenosis can progress and worsen, leading to complete blockage with time.
Treatment Options: From Non-Surgical to Surgical Solutions
The treatment for tear duct obstruction is determined by various criteria, including the patient’s age, the degree of the blockage, the underlying reason, and the presence of an infection. Let us explore both non-surgical and surgical therapy options.
Non-Surgical Treatments
- Massage and Warm Compress
A gentle massage (Crigler massage) over the tear sac area, along with warm compresses, will often assist in opening up the blockage in newborns with congenital blockage nasolacrimal duct obstruction. Parents are often demonstrated how to do this at home.
- Antibiotic Eye Drops or Ointments
If an infection is present, topical application with antibiotic eye drops or ointment are necessary as part of treatment. However, they do not address the problem itself.
- Nasal Decongestants and Anti-Allergy Medications
Decongestants and antihistamines may help with symptom relief especially in patients with allergic rhinitis and conjunctivitis contributing to their tearing.
- Observation
Doctors usually prescribe watchful waiting in congenital nasolacrimal duct obstruction, since the natural course of the condition means that most will resolve naturally by the age of one, without the need for medical intervention. In acquired nasolacrimal duct obstruction, patients who are fairly asymptomatic may choose a period of observation before deciding on further surgical intervention.
Minimally Invasive and Surgical Treatments
- Lacrimal Probing
This technique is frequently the first line of treatment for chronic congenital tear duct obstruction. The doctor uses a tiny probe to cannulate the duct and saline is flushed through to ensure the obstruction has been overcome.
- Balloon Catheter Dilation
Rarely, a small balloon is placed and inflated inside the tear duct to expand its diameter. It is a minimally invasive technique performed under anaesthesia, however recurrence of the obstruction is not uncommon.
- Stenting or Intubation
A tiny silicone tube or stent can be temporarily put into the duct to keep it open. This is often removed after a few months, when the duct heals and remains patent.
- Dacryocystorhinostomy (DCR)
This is the most commonly performed surgical technique on individuals who have chronic or severe tear duct obstruction. DCR opens up a new conduit for tears to drain from the eye into the nasal cavity, bypassing the obstructed duct. It can be done externally (by a small incision on the side of the nose) or endoscopically (through the nose with no visible scarring).
- Conjunctivodacryocystorhinostomy (CDCR)
When a normal DCR is not possible owing to total ductal damage or failed previous surgery, a glass tube known as a Jones tube may be used to drain tears from the eye straight into the nasal cavity.
Blocked Tear Duct Treatment at Asia Pacific Eye Centre
If you or your child experience symptoms of blocked tear ducts, schedule an appointment at Asia Pacific Eye Centre. At Asia Pacific Eye Centre, Dacryocystorhinostomy (DCR) is offered as an effective surgical solution for treating tear duct obstruction. As part of our comprehensive oculoplastic services, DCR is performed by experienced specialists and tailored to each patient’s unique needs. In addition to treating blocked tear ducts, our oculoplastic team also manages conditions like drooping eyelids (ptosis), eyelid malpositions (entropion, ectropion), eyelid tumours, ingrown eyelashes, and offers cosmetic eyelid surgeries.
