Blocked Tear Duct And Tearing
Q: What is a blocked tear duct?
A: When you have a blocked tear duct, your tears can’t drain normally, leaving you with a watery, irritated eye. The condition is caused by a partial or complete obstruction in the tear drainage system.
Tear duct obstruction is usually divided into 2 categories i.e for children and adults.
A blocked tear duct is common in newborns. The condition usually gets better without any treatment during the first year of life.
In adults, a blocked tear duct may be due to an injury, an infection or a tumour.
A blocked tear duct is almost always correctable. Treatment depends on the cause of the blockage and the age of the affected person.
Q: What causes a blocked tear duct?
A: Babies in utero have a thin membrane that seals the nasolacrimal duct. In newborns, a blocked tear duct may be the result of that membrane not opening as it should at birth.
Another cause of blocked tear duct may be chronic infections. Chronic sinusitis may irritate the tissues and form scars, which block the tear duct system.
Other causes of blocked tear duct:
Abnormal development of the skull and face. More commonly in people with Down syndrome or other disorders
Age-related changes including narrowing of the punctal openings.
Trauma, such as a fracture of the bones around the tear duct; scar tissue.
Conjunctivitis, infection and inflammation of the conjunctiva. In rare cases, the tear duct system may become infected and blocked, especially after some viral infections
Tumour, which may press on the tear duct system and prevent drainage.
Q: What are the signs of a blocked tear duct?
A: When tear ducts are blocked, trapped bacteria can lead to infection.
Symptoms can include:
Watery eyes or teary eyes
Recurrent eye infections and fever
Swelling, tenderness and redness of the inside corner of the eye or around the eye and nose
Discharge of mucus in the eye
This can get worse after a cold or sinus infection and is more noticeable after exposure to cold, wind or sunlight.
Q: How is diagnosis done?
A: To diagnose your condition, Dr Vanessa will discuss your symptoms, examine your eyes and run a few tests.
Tests used to diagnose a blocked tear duct include:
Tear drainage test. One drop of a special dye is placed on the surface of each eye and if approximately after 5 minutes most of the dye still remains, you may have a blocked tear duct.
Probing and Syringing. A slender instrument (probe) will be inserted through the tiny drainage holes at the corner of your lid to check for blockages. Sometimes, this probing may even fix the problem, especially in children. Syringing simply means to flush fluid into the tear drainage passage to check for blockage.
Eye imaging tests. Using an X-ray, computerised tomography (CT) or magnetic resonance imaging (MRI) an image can be taken to find the location and cause of the blockage.
Q: What are my treatment options?
A: Your treatment depends on what’s causing the blocked tear duct. Sometimes more than one approach is required to correct the problem.
Medications to fight infection. Antibiotic eyedrops or pills may be prescribed If your doctor suspects an infection in the eye
Watch-and-wait or massage. Babies born with a blocked tear duct often get better without any treatment as the drainage system matures after a few months. If this does not improve, a special massage technique can be applied to help open the membrane.
If you’ve had a facial injury that caused blocked tear ducts, sometimes your condition can improve as your injury heals and the swelling goes down.
Dilation, probing and flushing.For infants, this technique is done under general anaesthesia. The doctor enlarges the punctal openings with a special dilation instrument and inserts a thin probe through the punctal and into the tear drainage system. This relieves the obstruction and facilitates opening of the tear drainage passage.
Balloon catheter dilation.Usually used as a last resort, if other treatments haven’t worked or the blockage returns. It tends to be more effective for infants and toddlers, and may also be used in adults with a partial blockage.
Patients will be given general anaesthetic. Then the doctor threads through the tear duct blockage in the nose using a tube (catheter) with a deflated balloon on the tip. The balloon will be inflated and deflated a few times to open the blockage.
Stenting or intubation.Done under general anaesthesia, a thin tube, made of silicone is threaded through one or both puncta in the corner of your eyelid. These tubes then pass through the tear drainage system into your nose.
A small loop of tubing will stay visible in the corner of your eye, these tubes will be left in for about 3 months before they are removed.
If a tumour is causing your blocked tear duct, treatment will focus on the cause of the tumour.
Surgery may be performed to remove the tumour, or your doctor may recommend using other treatments to shrink it.
The procedure commonly used to treat blocked tear ducts is called dacryocystorhinostomy. This opens the passageway for tears to drain out your nose again.
This procedure requires general anaesthetic or local anaesthetic if it’s performed as an outpatient procedure.
The steps in this procedure vary, depending on the exact location and extent of your blockage.
With external dacryocystorhinostomy, an incision is made on the side of your nose, near where the lacrimal sac is located. After connecting the lacrimal sac to your nasal cavity and placing a stent in the new passageway, the surgeon closes up the skin incision with a few stitches.
Following surgery, your doctor will prescribe you eyedrops and a nasal decongestant spray to prevent infection and reduce inflammation. After three to six months, you might need to return to see your doctor and remove any stents used to keep the new channel open during the healing process.