Lacrimal System (Tear Ducts)

The lacrimal gland produces tears that enter into the "duct" that drain the tears from the eye into the nose. The most common symptoms are lacrimal system problems are excess tearing (tears may run down the face) and mucous discharge.   If one has a plugged tear duct or Nasolacrimal Duct Obstruction (NLDO), not only will tears spill over the eyelids and run down the face, but the stagnant tears within the system can become infected. This may lead to recurrent red eyes and infections. The excessive tearing can also produce secondary skin changes on the lower eyelids.

Congenital Nasolacrimal Duct Obstruction

Nasolacrimal Duct Obstruction (NLDO) is very common in infants. Children are frequently born with an obstruction within the tear duct. In fact, 6% of all children are born before their tear ducts are open.  The vast majority of these children have no problem, because the tear ducts open spontaneously.  If the ducts do not open quickly, the stagnant tears within the tear duct often become infected, causing pus to collect between the eyelids.  Antibiotics may help some of the symptoms, but this does not cure the blockage.  These obstructions may resolve spontaneously within the first few months of life. In fact, 95% of children will show resolution before their first birthday. Along with antibiotics, massage of the infected, blocked tear duct may help the duct open and the symptoms to resolve.   If it does not resolve, surgery may be necessary.  If the duct remains blocked after the baby is 6 months to about 1 year old, a probing procedure may be done. Outpatient surgical probing successfully opens the duct for about 90 out of 100 babies who have blocked ducts.  Newer techniques, including balloon dacryoplasty (balloon dilation of the tear ducts) have improved the success rate of treating blocked tear ducts.

Treatment of Adult Tear Duct Blockage

When the nasolacrimal duct, the tube which drains tears into the nose, is blocked, a surgical procedure is usually required.  When the nasolacrimal duct is only partially blocked your doctor will often attempt to widen the opening by flushing water through the duct.  An eye drop with both anti-inflammatory and antibiotic medications will then be prescribed in an attempt to reduce the swelling in the duct and promote tear drainage.  These attempts to open the duct are not often successful and may need to be repeated periodically.  When the tubes, called canaliculi, which drain the tears into the lacrimal sac are blocked surgical therapy is more complicated.  In most cases reconstruction of the canaliculi will be performed.  Eyelid weakness or malposition may be treated by surgically tightening and repositioning the lids.

BALLOON DACRYOPLASTY

This procedure helps to unstop blocked tear ducts by an outpatient procedure in which the tear duct system is dilated by using a high-pressure, specially designed balloon probe. The probe is inserted into the tear duct, and a specific protocol of inflation and deflation opens the system without cutting.  Along with placing temporary small silastic stents, the success rate is well over 90 %.

DACRYOCYSTORHINOSTOMY (DCR)

DCR is a same-day procedure.  You may choose to be either asleep under general anesthesia or awake with IV sedation.  A DCR is performed through a skin incision, which is made on the side of the nose.  An opening is created in the bone between the blocked tear sac and the nose, and the lining of the tear sac is then attached to the lining of the nose to form a permanent drainage for tears.  In most people, during surgery, a clear plastic tube is placed from the inside corner of the eye into the nose.  The tube is used to stent the tear drainage system and prevents scarring.  This tube is easily removed in the office in four to six months.  Additional treatment with anti-scarring drugs may be used within the surgical opening, which helps to improve the success rate.

When the surgery is completed, sutures are placed in the skin and usually dissolve in about a week or two. The scar produced may initially be red, hard and raised but will smooth out over the weeks and months after surgery.  A DCR can also be performed through the nose (called an endoscopic DCR).  This avoids a skin incision.  However, the success rate with this procedure is probably less than when the procedure is performed through the skin because the tear sac is not directly attached to the lining of the inside of the nose