Alternative Names occlusion of nasolacrimal duct (neonatal or acquired), dacryostenosis
Definition A blocked tear duct is an obstruction or complete scarring of the nasolacrimal (nay-zoh-la-cream-al) duct in the nose. This causes persistent tearing and production of discharge from the eye. Many people think a blocked tear duct means that tears cannot be released down onto the eye, resulting in dry eyes. The term really means a blockage of the drainage system for tears in the nose. This produces too many tears, a condition called epiphora (ip-if-or-ah).
What is going on in the body? Tears are produced by the lacrimal gland under the upper lid. The tears are constantly released onto the eye's surface in small amounts. Tears keep the cornea and the membrane that lines the inside of the eyelid and the surface of the eye (conjunctiva) (con-junk-tiv-ah) lubricated. Blinking moves tears toward the inside corner of the eye. There the tears drain into two small canals, one on the upper lid and one on the lower lid. Tears move through these canals into the nasolacrimal sac in the nose. From there the tears go down the nasolacrimal duct into the back of the nose and from there down the throat. If there is a barrier anywhere along this route, it is called a blocked tear duct. This can happen on one or both sides. Sometimes there is a history of a broken nose. The tear duct system can also become blocked from chronic nasal infections.
What are the signs and symptoms of the condition? The major symptom is constant tearing and watering of the eye. Tears run down on the face. Sometimes there is mucous on the lid margins and lashes. Occasionally there will be a secondary infection in the nasolacrimal sac. This causes tenderness on the side of the nose near the eye.
What are the causes and risks of the condition? Babies often have discharge and tearing of the eyes. This is because a membrane in the nose is blocked. Usually, it opens spontaneously at birth. Even if the membrane does not break during birth, the problem usually goes away after a few months. However, if the membrane does not open by itself in 6 to 9 months, the chance that it will self-correct is low. Treatment will be required.
Sometimes a past nose injury or frequent sinus infections can cause scarring of the nasolacrimal duct. This can cause complete blockage.
How is the condition diagnosed? Diagnosis in infants is made largely on the symptoms. When there is constant tearing and discharge in one or both eyes, a blockage is suspected. In an adult, frequent watering or infections leads to suspicion. An eye doctor can confirm the diagnosis by trying to rinse the nasolacrimal system. A small tube is placed into the opening on the lower lid and fluid is channeled into the nose. If it does not flow into the back of the nose and the person cannot taste it going down the throat, a diagnosis of a blocked tear duct is made.
What are the long-term effects of the condition? Infection can result if the nasolacrimal duct is not opened and tears are not allowed to flow freely. Tears and mucous can build up in the nasolacrimal sac creating an environment for infection. The constant watering and discharge of the eye can cause secondary infections of the eyelids and conjunctiva.
What are the risks to others? This is not a contagious disease.
What are the treatments for the condition? In babies, treatment consists of good eyelid hygiene and massage downward over the nasolacrimal sac with a cotton tip applicator. Sometimes this procedure will open the membrane at the end of the duct. If the tear duct has not opened spontaneously by 6 to 9 months of age, probing under anaesthesia is recommended. Probing will pop the membrane open in the nose. This does not require any cutting or stitches. For adults with an acquired blockage, surgery is recommended. The procedure is called a DCR, or dacryocystorhinostomy (dak-ree-oh-sis-tah-rye-nah-stah-mee). It creates a new opening in the nose for tears to flow into the back of the throat. There is no topical or oral medication to cure this problem. A blocked tear duct may respond to a massage over the lacrimal sac, several times a day, as shown by an ophthalmologist.
What are the side effects of the treatments? Side effects would include any complications possibly related to anaesthesia during surgery.
What happens after treatment for the condition? Following successful treatment and opening of the blockage, the individual should have no more watering or discharge of the eye.
Author: Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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