Clearing or Bypassing a Blocked Tear Duct — Lacrimal Surgery
The body produces tears continuously to lubricate and clean the eyes. The tears are drawn into a small hole in the inner corner of the eyelid known at the punctum. That is the start of a drainage system that eventually empties tears into the nose. Our tear drainage system doesn’t have much spare capacity; that’s why tears spill out onto our faces when we cry. Plus, the drainage channel is narrow and can narrow further with age. If blockage anywhere in the tear drainage system occurs the patient will have excessive tearing and typically will develop infections in the eyes and the tear ducts. At the Eye Institute at the Medical Center Clinic we use lacrimal surgery when necessary to clear blocked tear ducts.
The production and use of tears
Most of our tears are produced by our lacrimal glands, which are located above the outer half of each eye. The tears are a combination of water, oil, and mucus and they flow down across the surface of the eyes to lubricate and protect them, and then exit into the puncta, the holes in the corners of the upper and lower eyelids. The tears then travel through small canals in the eyelids (canaliculi) to a sac where the lids are attached to the side of the nose (lacrimal sac). The last passage is down the nasolacrimal duct and into the nose, where the tears are reabsorbed or evaporate.
Blocked tear ducts in children
Around one fifth of all newborns are born with a blocked tear duct, but the condition usually clears up on its own in the first four to six months as the child’s drainage system matures. Massaging the lacrimal sac is an easy and effective way to help clear a blockage in a newborn.
Blocked tear ducts in adults
If a blockage occurs at any point in the tear drainage system the tears won’t drain properly. This makes the person’s eyes continually watery, and it increases the risk of developing eye infections and chronic inflammation.
What causes a blocked tear duct?
Chronic nose infections can lead to duct blockage. Sinusitis can irritate the tissues and form scar tissue. These are other causes of tear duct blockage:
- Age-related changes. As we age, parts of the drainage system, such as the punta, narrow.
- Nose trauma. A broken nose or other damage can create scar tissue that blocks the tear duct.
- Nose polyps. Some people with nasal allergies can develop a growth in the lining that can create an obstruction.
- Conjunctivitis. Viral infections, such as those of the conjunctiva (the thin covering of the eye), can infect the tear duct system, creating a blockage.
- Tumors. A tumor in the area can press on the tear duct system.
Finding the blockage
It’s important to find exactly where the blockage is occurring. To do this, we use various tests. We will syringe water through the tear ducts to see if it exits the nose. We can use a special fluid for this that can be tasted in the throat if the duct is letting the fluid through. We may place an orange dye into the eye to see if the tears drain it normally. We may insert a thin metal tube into the tear drainage system to allow us to see if the tubes leading into the tear sac are open. We will attempt to flush water through the nasolacrimal duct into the nose to determine if the nasolacrimal duct is open. If we still need more information, we may opt for x-rays or a CT scan of the tear duct area (called a dacryocystogram).
Surgery to clear the blockage
Once we find the location of the blockage, we have various options for addressing the problem.
- Probing and dilation
In blockage with children and partial blockage in adults, we will place a thin probe into the punctal openings and through the entire drainage system into the nasal opening. We then remove the probe and flush the tear drainage system with water.
- Balloon catheter
If passages have narrowed or are blocked by scarring or inflammation, we may insert a narrow tube (catheter) with a deflated balloon on the tip all the way into the lower nasolacrimal duct. We then inflate and deflate the balloon along the drainage system to open it up.
We insert tiny tubes through one or both puncta in the corner of the eye and advance them all the way through the tear drainage system and out through the nose. A tiny loop of tubing remains at the corner of the eye. These tubes remain in place for three to four months and are then removed.
The problem with the above options is that the blockage will often redevelop. In those cases, dacryocystorhinostomy (DCR) is the surgical procedure we use. This technique is used to treat most cases of blocked tear ducts in adults, but rarely in children. The idea is to create a new route for the tears to drain out through the patient’s nose normally again. A new route between your lacrimal sac and your nose is created, bypassing the nasolacrimal duct, which is typically the blockage site. We place a tube inside the new opening while it heals, and then remove it in three or four months. Depending on your type of blockage, we may bypass the entire tear drainage system. We create a new route from the inside corners of your eyes (the puncta) to your nose. This is called a conjunctivodacryocystorhinostomy.