Tear Duct Obstruction

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Diagnosis

Diagnosis is based on symptoms. The cause of the tear duct blockage must also be identified. Tests are determined by the patient's age and symptoms.

The eye doctor takes a history of past medical and vision problems and current eye problems and may perform a basic eye exam. To determine the presence and extent of tear duct blockage, a fluorescein eye stain is used to observe the drainage of tears. An orange dye is placed in the eye using a dropper or blotting paper. After it covers the surface of the cornea, a blue light is shone on the eye to detect abnormalities on the cornea, including delays in tear drainage.

An internal examination of the nose may be indicated, especially if an injury has occurred. Imaging tests and x-rays also may be warranted to rule out other causes, such as a tumor. In adults, a fluid is irrigated through the nasolacrimal drainage system to locate and determine the extent of the blockage.

Treatment

Treatment depends on the symptoms, the cause, and the age of the patient. If an infection is present, it is treated first. Oral antibiotics are generally the treatment of choice, but in some cases, antibiotic eye drops or ointment may be prescribed. If the infection occurred as a result of an obstructed duct, other measures are implemented.

A blocked duct in an infant is treated by gently massaging the area between the eye and nose several times a day. This treatment is usually successful in opening a blockage or helping to move a blockage that is in the process of self-resolving. If tearing is persistent beyond 1 year of age or if the affected eye is infected, a surgical procedure is performed.

In adults, the cause of the blockage must be determined. If an infection clears and the duct remains obstructed, or if an infection recurs, further treatment may be necessary.

In children and adults, a duct can sometimes be reopened by placing a small probe into the duct. If this does not remove the obstruction, a silicone tube can be inserted to maintain an opening. In children, the tube usually must remain in position for 6 to 12 months, until the tear duct stays open by itself. The drawback to this method is that a second procedure may be necessary to remove them.

Surgery
If conservative measures fail, patients may require a procedure called dacryocystorhinostomy, the creation of a new passage for tears to flow. This is performed in a hospital, under general anesthesia. The procedure is more than 90% successful in relieving the blockage.

If the tear duct is damaged beyond repair due to chronic infection or injury, an artificial duct can be surgically implanted. The artificial tear duct, called a Jones tube, is placed behind the inner corner of the eyelid to drain tears into the nose.

Tumors or nasal polyps that cause obstruction usually are removed surgically.

Prevention

In many cases, tear duct obstruction cannot be prevented. Safety precautions should be taken when playing contact sports and performing other types of physical activities (e.g., wearing helmets and face masks) to prevent trauma to the face. Prompt and adequate treatment for nasal and eye infections may also reduce the risk.

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