Our tears are secreted by multiple tear glands located in and around the eye. Once the tear’s job in the eye is done, it is drained away from the eye through tear ducts. These ducts start from the inner side of the eyelids and extend all the way to the nose. Unbeknownst to us, our tears are channeled towards the nose through these ducts. Tear duct obstruction refers to a blockage at any level of these ducts, preventing proper drainage.
What are the causes of tear duct obstruction?
- Congenital Tear Duct Obstruction: When the tear duct fails to open at birth (congenital tear duct obstruction).
- Eye Infections: Infections affecting the eye.
- Eye Allergies: Allergic reactions involving the eye.
- Inflammation: Inflammation in and around the tear ducts.
- Prolonged Use of Eye Drops: Long-term use of certain eye drops.
- Trauma: Injury or damage to the tear duct due to trauma.
- Eye and Periocular Surgeries: Surgeries involving the eye and the surrounding area.
- Tear Duct Infections: Infections affecting the tear ducts.
- Damage During Rhinoplasty or Other Nasal Surgeries: Injury to the tear duct during rhinoplasty or other nasal surgeries.
- Nasal Allergies: Allergies affecting the nose and nasal passages.
There are various reasons that can lead to tear duct obstruction.
Tear duct obstruction: what symptoms does it cause?
Tear duct obstruction can lead to several noticeable symptoms, including:
- Constant Watery Eyes (Epiphora): Persistent excessive tearing, resulting in watery eyes.
- Occasional Crusting: Formation of crust or discharge around the eyes from dried tears.
- Redness: The eyes may appear red or bloodshot.
- Burning Sensation: A sensation of burning or discomfort in the affected eye.
- Inner Corner of the Eye Inflammation: Inflammation and irritation of the inner corner of the eye.
Is tear duct blockage a dangerous condition?
We can liken the tear duct to a small stream. Any constriction or blockage that occurs anywhere in the stream would result in the accumulation of debris downstream, just like twigs and branches collecting behind a dam in a river. Therefore, when the tear duct becomes blocked, it means that behind the blockage, microorganisms and impurities can accumulate in the eye. This can lead to the development of eye infections, such as conjunctivitis and keratitis, among others. Unfortunately, it can sometimes lead to serious eye infections that can result in vision loss. In some cases, an infection can even develop within the tear duct itself (dacryocystitis). These infections can spread extensively, involving the skin, orbit, sinuses, and even the brain.
How is tear duct blockage diagnosed?
Persistent and unrelenting tearing, especially tearing that occurs for no apparent reason while at home, is the most important symptom of tear duct blockage. Eye specialists can directly examine the tear duct in adults through a procedure called tear duct irrigation. During this procedure, the level of blockage in the duct can be identified, and potential surgical planning can be done. Other tests such as tear disappearance time (especially in children), dacryography, and dacryoscintigraphy are also used. If there is any suspicion of a lesion, tumor, or trauma within the nose, computerized tomography (CT) scans and MRIs may be employed for further evaluation.
What is the treatment for tear duct blockage?
The treatment for a blocked tear duct is surgery. However, if there is an infection, it is important to first treat and control the infection. Depending on the level and severity of the blockage, the following surgical options are available:
- Probing
- Lacrimal intubation
- Laser DSR (Dacryocystorhinostomy)
- External DSR (Dacryocystorhinostomy)
- Endoscopic DSR (Dacryocystorhinostomy)
- Conjunctivodacryocystorhinostomy
- There are many other surgical techniques, such as canaliculi rhinostomy.
Can the duct get blocked again after surgery?
After the surgery, it is possible for the duct to become blocked again, although the success rate of the surgery is typically above 90%. If it becomes blocked again after the surgery, it is possible to perform another surgery.