What is Tear Duct Obstruction?

What is Tear Duct Obstruction?

Tear Duct Obstruction causes the eye, which should remain moist, to not be moistened. This eye condition is seen as a result of blockage in the channels where tears secreted through the lacrimal glands are transmitted. Lacrimal duct obstruction, defined as a disorder seen in this channel, which has the function of advancing tears, can negatively affect a person’s life.

Tear Duct Obstruction, which occurs as a result of blockage of the tear ducts, causes tears that should flow into the nose to flow out of the eyelids. The flow of tears out of the eyelids can cause inflammation around the eyes and on the face. After this infection, pain and redness can occur around the eyes.

How Does The Tear System Work?

In the natural eye structure, the function of tears is to keep the eye wet. This wetness should be at a level that will protect eye health, excess tear will be expelled through the tear duct to the nose. The natural structure keeps the eye wet but does not provide excessive wetness.

Tears are produced in the lacrimal sac located at the upper side of the eye. The produced tears are responsible for wetting the eye and protecting the health of the upper layer of the eye.

After the eye is wet, the tears are transferred into the tear duct, which is an opening called the punctum at the root of the nose. The punctum is the starting point at the top of the tear duct. The tears passing through the punctum progress within the duct. The end point of the duct is the inside of the nose.

What is Partial Tear Duct Obstruction?

Sometimes the tear duct can narrow in different ones before it is attached. Narrowing of the tear duct (dacryostenosis) can cause partial obstruction of the tear duct.

In the event of a partial obstruction, tears accumulate and do not flow properly. This accumulation of tears can lead to infection.

What are The Causes of Tear Duct Obstruction?

1. Congenital Tear Duct Obstruction Cause:

It is the failure of the baby’s tear ducts to complete their formation during their development in the womb. Usually, the problem is that the baby is born without perforating the membrane where the tear sac opens into the nose. In this case, tears cannot drain into the nose.

2. Acquired Tear Duct Obstruction Cause:

In later ages, tear duct system obstruction may develop due to reasons that are not fully understood. Mostly, obstruction develops in the lower part of the sac. However, obstruction may also develop in any part of the tear duct system (duct mouth, canal, inside the sac).

The diseases that can cause acquired tear obstruction can be listed as follows;

• Sinusitis
• Some infections and inflammations
• Tumor
• Some traumas
• Lacrimal sac stones

What are The Symptoms of Tear Duct Obstruction?

• Excessive Tearing (Epiphora):

There is constant watering in the eyes; tears may even flow down the cheeks.

• Eye Smuts:

Especially in the morning, there may be sticky crusts on the eyelashes.

• Blurred Vision:

Constantly watering eyes can prevent clear vision.

• Swelling and Redness Around the Eye:

It becomes apparent in the area close to the tear duct, especially if there is an infection.

• Pain:

There may be mild to severe pain in the inner corner of the eye (close to the nose).

• Pus Flow When Pressed on the Tear Duct:

This condition is usually a symptom of infection (dacryocystitis).

• Burning and Stinging Feeling in the Eye:

It is especially seen in long-term obstructions.

Who Are At Risk for Tear Duct Obstruction?

1. Newborn Babies:

• They are the most common risk group.
• Obstruction occurs when the membrane at the lower end of the tear ducts does not open after birth.
• They usually open on their own by age 1, but sometimes intervention is required.

2. Middle-Aged and Older Women:

• They are more common, especially in women over the age of 40.
• The tear duct diameter is narrower in women than in men.
• Hormonal changes and tissue weakening due to aging may be effective.

3. Those with Chronic Eye and Nose Diseases:

• Chronic conjunctivitis (eye inflammation)
• Those with chronic sinusitis or nasal allergies
• Continuous inflammation can cause narrowing and obstruction in the ducts.

4. Those with Familial (Genetic) Predisposition:

• The risk increases in people with similar problems in the family.
• Genetically narrow tear duct structure can trigger this condition.

5. Those Who Have Facial and Nasal Trauma:

• Nasal fractures, blows to the facial area
• Can disrupt the structural integrity of the tear duct.

6. Those Who Have Surgery or Radiotherapy:

• Surgical interventions, especially to the nose, eyes or facial area
• Tissue hardening and deterioration in the canal structure may occur after radiotherapy.

7. Those Who Use Certain Medications:

• Long-term use of eye drops (especially glaucoma medications)
• These medications can damage the inner surface of the tear duct.

How is Tear Duct Obstruction Diagnosed?

1. Physical Examination:

• Symptoms such as watering, redness, and crusting in the eye are evaluated.
• The area where the tear duct is located is checked for tenderness or swelling.

2. Tear Duct Washout Test (Lacrimal Irrigation):

• A thin cannula (a thin tube like a needle) is placed in the tear duct.
• Saline is administered into the duct.
• If the fluid comes from the nose, the duct is open.
• If it does not come or if it returns, there is a blockage.

3. Tear Duct Imaging Methods:

Dacryoscintigraphy:

• A drop containing a radioactive substance is dropped into the eye, and the flow of the tear duct is followed.
• It is especially used to determine the location of partial blockages.

Dacryocystography (DCG):

• Contrast material is injected into the tear duct and an x-ray is taken.
• The exact location of the blockage can be determined.

CT or MR Dacryocystography:

• It is preferred when more detailed imaging is needed.
• It is used especially if there is a suspicion of a tumor or structural disorder.

4. Tear Dye Test (Fluorescein Test):

• Yellow-green fluorescein drops are dropped into the eye.
• After a while, it is checked whether it reaches the nose.

What are The Treatment Methods for Tear Duct Obstruction?

Treatment for Tear Duct Obstruction in Babies and Children:

1. Crigler Massage (Eye Massage):

When is it Done?

• It is the first preferred treatment method for babies between 0-12 months.

How is it Done?

• Light pressure is applied with a finger just above the tear duct and massage is done towards the nose.
• It is repeated 3-4 times a day, 10-15 times each time.
• When applied correctly and regularly, close to 90% success can be achieved.

What does it Do?

• It helps to open the membrane causing the obstruction.
• It provides natural tear flow.

2. Antibiotic Eye Drops or Ointment:

• Used if there is inflammation in the eye (pus, redness, discharge).
• Applied with massage.
• Treats the infection but does not permanently resolve the blockage.

3. Probing:

When is it Done?

• After the 6th month, in cases that do not improve with massage.
• The ideal time: Between 6 and 12 months (the success rate is higher if done early).

How is it Done?

• A thin rod (probe) is placed in the tear duct to open the blockage.
• It is usually done in a short time under light anesthesia.
• The procedure takes 5-10 minutes, and most children get results in one go.

4. Second Probing or Balloon Dilation:

• It can be repeated if the first probing is unsuccessful.
• In some cases, a balloon is placed inside the canal and inflated and expanded.
• This method is usually applied in children over 1 year of age.

5. Silicone Tube Application:

• It is preferred in cases of persistent or recurrent obstructions.
• A thin, flexible silicone tube is placed in the tear duct.
• It remains in place for 2–6 months and is then removed.

6. Surgical Intervention (Very Rarely Necessary):

• It is usually applied in children over 3 years of age if all other methods are unsuccessful.
• A new tear duct is created with DCR (Dacryocysthinostomy) surgery.
• It can be done endoscopically, through the nose (no scars).

Treatment of Tear Duct Obstruction in Adults:

1. Medical Treatment:

Antibiotic Drops or Ointments:

• Used to treat infections.
• Provides temporary relief.
• Not a permanent solution.

2. Probing:

• Can usually be used in infants or young children. A thin probe is used to gently open the obstruction.

3. Balloon Dilation:

• A small balloon is placed in the tear duct with the help of a catheter to expand it. This method provides expansion to open the obstructions.

4. Stent or Tube Placement:

• A thin stent or tube is placed to keep the duct open. It is usually preferred for severe obstructions.

5. Dacryocystorhinostomy (DCR):

• It is a surgical intervention in cases of chronic obstruction.
• A new channel is opened between the lacrimal sac and the nasal cavity. And it provides drainage of tears.
• It can be done with traditional surgical methods or endoscopically.

How to Prevent Tear Duct Blockage?

1. Pay Attention to Eye Hygiene:

• Avoid touching your eyes when your hands are dirty.
• If you wear makeup, remove it every day, especially eye makeup.
• If you wear contact lenses, strictly follow the rules of hygiene.

2. Treat Eye Infections Early:

• Conditions such as conjunctivitis (eye inflammation) can block the tear ducts.
• See an eye doctor without delay if you notice signs of infection (redness, discharge, stinging sensation).

3. Avoid Allergens:

• Avoid substances that irritate the eyes such as pollen, dust, and smoke.
• Allergic eye diseases can also cause the ducts to become blocked with chronic irritation.

4. Maintain Nasal Health:

• Upper respiratory tract infections (colds, sinusitis) can affect the tear ducts.
• Such infections should be treated before they become chronic.

5. Don’t Neglect Nasal Cleaning:

• Especially in babies and children, nasal congestion can affect tear flow.
• Nasal aspirators or serum physiological solutions can be used to clean the nose.

6. Avoid Trauma:

• Blows to the face or nose area can damage the tear duct.
• Wearing protective equipment while doing sports can be helpful.

7. Chronic Tear Flow Should Be Taken Seriously:

• If there is constant tear flow, this may indicate a problem with the tear duct.
• Early treatment can prevent the progression of the blockage.

What Should Patients with Tear Duct Obstruction Pay Attention to?

1. Pay Attention to Eye Hygiene:

• Keep the eye area clean.
• If there is discharge from your eyes, gently clean it with boiled and cooled water.
• Do not share the towels and make-up materials you use with anyone.

2. Avoid Rubbing the Eyes:

• Scratching or rubbing the eyes can increase the obstruction and increase the risk of infection.
• If there is itching, consult your doctor and use appropriate drops.

3. Apply Warm Compress and Tear Duct Massage (With Doctor’s Approval):

• Massage and warm compress are quite effective, especially in babies and in mild obstructions.
• It is important to perform the massage with the proper technique (I can show you how if you want).
• The compress can be applied 2-3 times a day with a clean cloth.

4. Observe Signs of Infection:

• If there is severe redness, yellow-green discharge, swelling and pain in the eyelid, an infection may have developed.
• In this case, an eye doctor should be consulted immediately.

5. Do Not Use Eye Drops Other Than Prescription Medicines:

• Always use eye drops or antibiotics with a doctor’s prescription.
• Incorrect drops are both useless and can worsen the condition.

6. Avoid Dusty, Dirty Environments:

• Causes more irritation to the eyes.
• Wearing glasses can help protect the eye in such environments.

7. Post-Surgery Care is Important:

If surgery (e.g. DCR – dacryocystorhinostomy) was performed for obstruction:

• Keep the stitches clean.
• Use the drops recommended by the doctor regularly.
• Follow the instructions given after the surgery exactly.

8. Don’t Neglect Regular Follow-Ups:

• Tear duct obstruction can become chronic.
• The degree of obstruction should be monitored with doctor check-ups.