Blocked tear ducts or obstruction of the nasolacrimal duct (tear drainage system) prevents tears from draining resulting in watery, irritated eyes.
Nasolacrimal duct obstruction (blocked tear ducts) can occur in a large number of newborn infants. Fortunately, with growth, 90% of nasolacrimal duct obstruction cases clear up within the child’s first year with little or no treatment.
Anatomy of Blocked Tear Ducts (Nasolacrimal Duct)
The tear ducts secrete small amounts of fluid, what is seen as the watery part of tears, to help lubricate the eyes and keep them from drying out. The tears contain antibodies that help protect the eyes from infection.
Lacrimal gland is the gland that produces tears, and the tears drain out onto the eye through two openings called the lacrimal ducts. Following this, the tears drain into the lacrimal sacs and then down to the nasolacrimal ducts inside the nose. When the nasolacrimal ducts have a blockage and are not draining correctly, the tears have no room to flow, causing build up and increased risk of infection.
Eye drops will not be applied to combat the issue of the nasolacrimal duct obstruction. This has to be addressed in surgery, providing the problem does not correct itself within a few months of the child’s life. Eye drops will be prescribed by a doctor if an infection develops and he or she sees fit to address this with something more than over-the-counter drops.
Causes of Nasolacrimal Duct Obstruction
- Membrane at the end of the tear duct (Valve of Hasner) does not open at birth is the most common cause
- Eyelid openings (puncta) fail to form
- Tear duct drainage system is too narrow
- Infection of the nasolacrimal duct
- Nasal bone obstruction preventing the nasolacrimal duct from entering the nose
Dacryocystitis – Infection of the Nasolacrimal Sac
Nasolacrimal duct obstruction can lead to an accumulation of fluid and trapped bacteria in the nasolacrimal sac resulting in an infection called dacryocystitis.
Symptoms of Dacryocystitis
Swollen and tender bump under the lower eyelid on the inside corner of the eye. Symptoms of dacryocystitis include:
- Pain and redness around the eyes
- Watery eye
- Recurrent eye infections
- Crusty eyelashes
- Sticky eye mucus discharge
- Blurred vision
- Blood-tinged tears
Blocked Tear Duct Surgery
Prior to recommending a blocked tear duct surgery, a doctor will suggest a couple of other options designed to clear up the issue of blocked tear ducts in children. A doctor may recommend that a parent massage the infant’s eye several times daily for a couple of months or prescribe ointments or eye drops to address an infection.
If after a few months, the infant’s condition has not improved or he/she has experienced a serious infection or repeated infections, the doctor will most likely address the condition surgically.
Blocked tear duct surgery has an 85-95% rate of success for babies 1-year-old or younger, with the success rate dropping with increasing age of children. If the blocked tear duct surgery is not immediately successful, the process may be repeated until the problem is corrected.
The probe will be done in outpatient surgery, providing the child is not already admitted to hospital for a severe infection, and will be done so under general anesthesia.
Blocked Tear Duct Surgical Procedure
This procedure lasts around ten minutes, during which a thin and blunt metal wire is gently passed through the tear duct to open any obstruction. Following this, sterile saline solution is sent through the duct in the nose to ensure there is a free-flowing passageway. Following dacryocystorhinostomy, it is unlikely that there will be any discomfort for the child.
The doctor will assess whether the blocked tear duct surgery has been successful, and if not, the same procedure may be completed again to clear the blockage in its entirety. If unsuccessful or if the child is older or has a notably difficult blockage, the doctor may try a different method of surgical treatment.
Other possible treatments for a blocked tear duct are:
- Lacrimal silicone tube intubation: Procedure in which silicone tubes are placed through the tear ducts in order to stretch them and left in the ducts for up to 6 months, at which time, the doctor will remove them in-office
- Balloon catheter dilation: Tiny balloon is inserted through an opening in the corner of the eye, into the tear duct, and inflated with a sterile solution to expand the tear duct, then deflated and removed from the eye
Both of these procedures are quick and can be done as an outpatient, but under general anesthesia.
It may be a week before the symptoms improve, during which time your doctor will give you antibiotic ointment or drops and specific instructions on how to care for your child.