What is a Nasolacrimal Duct Obstruction?
It is a blockage of the tear drainage system. The tears drain from the eye into the nose. There is an opening of the drainage system on the medial portion of the eyelids called the puncta. The canaliculi (canals or ducts) drain the tears into the lacrimal sac between the eyelids and nose. The tears flow from the lacrimal sac into the nose.
Signs and Symptoms of Blocked Tear Ducts
Tearing (epiphora), large tear lake, recurrent eye infections, recurrent conjunctivitis, discharge, and swollen or infected lacrimal sac on the side of the nose medial to the lower lid are common.
Causes of Nasolacrimal Duct Obstruction
The blockage can occur anywhere along the tear drainage system. This can be a closing of the puncta to a blockage where the duct enters the nose.
Congenital Nasolacrimal Duct Obstruction
This occurs after birth and usually is a blockage at the entrance to the nose.
Older adults may have changes that occur in the bone structure and blockage near the nose or scarring of the puncta. Women tend to have this more commonly.
Chronic infections or inflammation can cause scarring and blockage.
Topical Eye Medications
Long-term use of certain medications such as those treating glaucoma and those containing corticosteroids can cause a blockage.
Trauma to the Face
Injuries to the mid facial structures can cause blockage.
Cysts or Stones in the Lacrimal Duct
Stones may develop in the lacrimal duct. Cysts may also develop in the lacrimal ducts.
Growths or Tumors
Tumors or growths in the lacrimal system or nasal cavity may cause a blockage.
Diagnosis and Tests for Nasolacrimal Duct Obstruction
Fluorescein Dye Test
Fluorescein dye is instilled into the eye and if there is still a significant amount of Fluorescein dye still present then you may have a blocked tear duct.
Simple Irrigation and Probing
The puncta at the medial end of the eyelid may be dilated if too small and an irrigation cannula is inserted into the canaliculus. Saline is then irrigated into the tear duct to see if the fluid enters the nose. The fluid may easily enter the nose, enter with pressure, or be totally blocked.
Dacryocystography or Dacryoscintigraphy (Tear duct imaging)
A contrast dye is injected into the nasolacrimal duct system and then images are taken to determine the location of the blockage.
Treatment of Nasolacrimal Duct Obstruction
Treatment will be based on the cause of the nasolacrimal duct obstruction. Congenital nasolacrimal duct obstruction is discussed in another Total Eye page.
If an infection is present in the beginning, antibiotics topical and/or systemic will be prescribed. As long this resolves the problem nothing else may be done. If the infection continues to return, is severe, or fails to resolve with antibiotics then other treatments should be considered.
Dilation and Irrigation
The puncta may be dilated if narrow. A cannula is then inserted and saline or fluid in injected into the tear duct.
Balloon Dilation of the Nasolacrimal Duct
A tube with a balloon catheter is inserted into the nasolacrimal duct system and then inflated to open the drainage system.
Lacrimal Duct Tubes or Stents
In partial duct obstructions, a silicone tube will be passed from the puncta into the nose. This is left in place for two to six months and then removed.
This surgery involves making an opening between the nose and lacrimal sac. This can be done by an external approach through the skin medial to the lower eyelid. An endoscopic approach can be performed from inside the nasal cavity into the lacrimal sac.