Definition

A lacrimal duct obstruction is blockage of the tear
duct, the thin channel that normally drains tears from the
surface of the eye.

Description

The lacrimal glands, located above each eyeball,
produce tears. The tears flow over the eye, then drain
through the nasolacrimal ducts. A tiny hole at the inner
edge of each eyelid marks the opening of the ducts,
which lead to the lacrimal sacs located on the side of the
nose. The tears pass from the sacs into the nasolacrimal
ducts and then into the nose.

When a tear duct becomes obstructed, tears may spill
over the eyelids and run down the face. Stagnant tears
within the system can become infected, leading to recurrent
red eyes and infections. Excessive tearing can also
produce secondary skin changes on the lower eyelids.

Causes and symptoms

An obstructed lacrimal tear duct can result in
inflammation and infection of the lacrimal sac. The area
beneath the eyes next to the nose can become red,
inflamed, and sensitive to the touch. The area usually is
swollen, and there may be a mucous discharge from the
opening of the nasal corner of the eye. Common complaints
include itching, irritation, burning, redness, foreign
body sensation, and tearing.

Children frequently have a congenital lacrimal duct
obstruction. Six to ten percent of all children are born
before their tear ducts are open.

In adults, a common cause of lacrimal duct obstruction
is involution, which is progressive degeneration
occurring naturally with advancing age, resulting in
shrivelling of organs or tissues. Other causes include
eyelid disorders, infections by bacteria, viruses, fungi,
and parasites, inflammations, the use of eye drops or
excessive nasal spray, systemic chemotherapy, trauma
from previous surgeries, injury to the bone at the side of
the nose, foreign bodies, sinus disease, nasal polyps, and
malignant or benign tumors.

Diagnosis

If the primary symptom is excessive tearing, the first
step is for the health care professional to determine if the
overflow of tears is due to an increase in tear production
or a decrease in tear drainage. Causes of increased tear
production may include trichiasis, a disease in which the
eyelashes produce constant irritation, and eyelid malpositions
and diseases. If abnormal tear production is ruled
out, then obstructions in tear drainage is the most likely
cause of the excessive tearing. Additional observations of
swollen lacrimal sac area and purulent eye discharge
indicate that there may be a lacrimal duct infection present.
To further define the diagnosis, the lacrimal discharge
may be cultured to determine possible infective
agents, while various imaging techniques may be used to
detect the type of obstruction. Dye tracer tests are also
used to test for blockages.

Treatment

Lacrimal duct obstructions in children often resolve
spontaneously, with 95% showing resolution before the
child is one year old. Daily massaging of the lacrimal sac
may help open the blockage. A topical antibiotic ointment
may be applied if infection is present. If the blockage is
not resolved after several weeks to months of this therapy,
a physician may attempt forceful irrigation. Surgical
probing to open up the duct under general anesthesia is a
last resort, after a year or so of less invasive treatments.
In adults, conservative treatments are usually recommended.
The infected or inflamed area may be massaged,
with warm compresses applied to provide relief and speed
the healing process. The health care provider may also
massage or irrigate the infected area. Topical antibiotic
ointments and oral antibiotics may also be used reduce
infection. The use of analgesics such as aspirin may be
recommended to control discomfort and reduce swelling.
Severe cases may require surgical intervention to prevent
future recurrences. Surgical approaches include insertion
of a probe or catheter to remove an obstruction or creation
of an artificial duct to bypass the obstruction.

Prognosis

If more conservative approaches fail to clear the
obstruction, surgical procedures are available, with success
rates greater than 90%.

Prevention

In many cases, the cause of a lacrimal duct obstruction
is not known. However, in some cases, lacrimal duct
obstruction may be caused by smoking and abuse of
nasal sprays.