Blocked Tear Duct

Diagnosis

For diagnosing your condition, a healthcare provider will discuss symptoms, conduct eye examinations, and perform tests. Furthermore, an examination of the interior of the nose might be conducted to identify potential structural issues within nasal passages causing an obstruction. When a blocked tear duct is suspected, additional tests could be administered to locate the blockage site.

Eye and nose examinations may include:

• Tear Drainage Test: This evaluates tear drainage speed by applying a special dye drop to each eye’s surface. If, after five minutes, most of the dye remains on the eye’s surface, it might indicate a blocked tear duct.
• Irrigation and Probing: A healthcare provider may introduce a saline solution into your tear drainage system to assess its efficiency. Alternatively, a slim instrument could be gently inserted through the small drainage holes at the corner of your eyelid (known as puncta) to identify potential obstructions. Sometimes, this probing might even resolve the issue.
• Eye Imaging Tests: These procedures involve passing a contrast dye through the puncta at the corner of your eyelid and through the tear drainage system. Then, X-rays, computerized tomography (CT), or magnetic resonance imaging (MRI) scans are employed to locate and determine the cause of the blockage.

Treatment

The approach to treating your condition is determined by the underlying cause of the blocked tear duct. It’s possible that more than one method will be necessary to correct the issue. In cases where a tumor is responsible for the blockage, the treatment will primarily target the tumor’s cause. Surgical intervention might be necessary to remove the tumor, or alternative treatments could be suggested by your healthcare provider to reduce its size.

• Medications: If the blockage is a result of an eye infection, your healthcare provider might recommend oral antibiotics or medicated eyedrops as part of the treatment.
• Watch-and-wait or massage: Newborns with blocked tear ducts often recover naturally without treatment as their drainage system matures in the initial months of life. Sometimes, a delicate tissue membrane covering the opening leading to the nose, known as the nasolacrimal duct, remains. If improvement doesn’t occur, healthcare providers might guide parents in a massage technique to help open the membrane.

In cases of blocked tear ducts due to facial injuries, waiting a few months while the injury heals is often recommended. As swelling subsides, the tear ducts may naturally become unblocked.

• Dilation, probing and flushing: In infants, this method is performed under general anesthesia. The healthcare provider widens the punctal openings using a specialized dilation tool and inserts a thin probe into the tear drainage system through the puncta.

In adults with partially narrowed puncta, the provider might expand the puncta using a small probe and then flush the tear duct in a procedure called irrigation. This straightforward outpatient technique often offers temporary relief.

• Stenting or intubation: Usually performed with general anesthesia, this method involves threading a thin silicone or polyurethane tube through one or both puncta at your eyelid’s corner. The tubes navigate through the tear drainage system and into your nose, leaving a small loop of tubing visible in your eye’s corner. Typically, in place for around three months, the tubes are then removed. Potential complications include inflammation due to the presence of the tube.
• Balloon catheter dilation:  When alternative treatments prove ineffective or if the blockage recurs, this technique can be employed. It’s generally successful for infants, toddlers, and adults with partial blockages. Beginning with a general anesthetic, a catheter tube is threaded through the blocked tear duct in the nose. The tube features a deflated balloon at its tip, which is inflated and deflated multiple times to clear the obstruction.
• Surgery: The procedure commonly employed to correct obstructed tear ducts is referred to as dacryocystorhinostomy. This surgical intervention aims to restore the normal flow of tears from your eyes to your nose. Depending on the situation, either a general or local anesthetic may be administered, especially for quicker procedures.

The specific approach to the surgery may vary depending on factors such as the location and extent of the blockage, as well as the surgeon’s expertise and preferred techniques.

• External Approach: In this procedure, an incision is made on the side of the nose, in proximity to the lacrimal sac. The lacrimal sac is then connected to the nasal cavity, and a stent is placed in the newly established passage. The incision on the skin is closed using a few sutures.
• Endoscopic or Endonasal Approach: This technique involves the use of a microscopic camera and small instruments inserted through the nasal opening to access the duct system. Unlike the external approach, this method does not require any external incisions and thus does not result in visible scarring. However, it’s important to note that the success rates of this approach are generally not as high as those of the external procedure.

After the surgery, a nasal decongestant spray and eye drops will be prescribed to you. These medications serve to prevent infection and minimize inflammation. Approximately 6 to 12 weeks post-surgery, you will have a follow-up appointment at your healthcare provider’s office. During this visit, any stents that were employed to maintain the openness of the newly created passage throughout the healing period will be removed.