Blocked Tear Duct
A blocked tear duct occurs when the tear drainage system becomes partially or completely obstructed. While blocked tear ducts are most frequently seen in babies, they can occur at any age and have a variety of causes.
In most cases, blocked tear ducts resolve without medical intervention and do not cause any permanent eye problems. In some cases, however, a blocked tear duct will need medical treatment and may indicate a more serious problem, such as a tumor. As such, it is important to consult with one of our experienced Orange County ophthalmologists if you suffer from a blocked tear duct.
Symptoms of a Blocked Tear Duct
- Excessive tearing
- Swelling and pain around the inside corner of the eye
- Recurrent eye infections and/or conjunctivitis (inflammation of the eye)
- Yellow or white mucus on the surface of the eye that may also build up in the corners of the eye
- Crusty eyelashes
- Blurred vision
These symptoms can be caused by the blocked tear duct or may be a side effect an infection that has occurred due to the blockage.
What Blocks My Tear Ducts?
Tears are primarily produced by the lacrimal glands, which are located inside the upper eyelids over each eye. In a healthy eye, tears travel down from these glands over the surface of the eye and drain into tiny holes known as puncta, which are located in the corners of the upper and lower eyelids. From here, the tears move into the lacrimal sac located at either side of the nose where they then flow down a duct that drains into the nose. A blockage can occur anywhere within this complex and delicate drainage system. If this happens, tears will be unable to drain properly, resulting in watery, leaking eyes and increasing the risk of infection and inflammation.
A blockage within the tear drainage system can be caused by a variety of reasons and can happen at any age. Common causes include:
- Congenital blockage: Up to 6% of infants are born with a blocked tear duct, making it one of the more common eye problems to affect infants. Blocked tear ducts in babies typically resolve on their without the need for medical treatment.
- Chronic eye infections and/or inflammation: Recurrent infections and inflammation of the eyes, tear drainage system, or nose (e.g. sinus infections) can result in blocked ducts.
- Nasal polyps: Polyps grow from the lining of the nose and can obstruct the tear duct system.
- Facial injuries: A blockage may occur if an injury or trauma to the face damages bone or cartilage structures near the tear drainage system.
- Aging process: With age, the tear drainage holes become smaller, which can result in a partial or total blockage.
- Tumors: It is possible for tumors to grow along the tear drainage system in the nose, sinuses or lacrimal sacs, which can cause blockages as they grow larger.
- Medications: Certain medicines, such as topical medications to treat glaucoma or cancer treatments, can cause blocked tear ducts.
Diagnosing a Blocked Tear Duct
To diagnose a blocked tear duct, our Huntington Beach ophthalmologists conduct a thorough eye exam and use a few tests to determine how well the patient’s tears are draining. During the appointment one or more of the following tests may be conducted to identify the cause and location of the blockage:
- Irrigation and probing: Our eye doctor may irrigate the tear drainage system with a saline solution to determine if it’s draining properly. Alternatively, a tiny probe may be inserted through the puncta at the corner of the eyelids to check for blockages. In some cases, the probing alone may resolve the issue.
- Tear drainage test: This test uses a special dye to determine how quickly tears are being drained from the eye. Our eye doctor will place one drop of fluorescein dye into each eye and will check how much dye is left in the eye after several minutes. A significant amount of dye remaining in the eye may indicate a blocked tear duct.
- Eye imaging tests: At Beach Eye Medical Group, we can use the most advanced eye imaging technology available today, including computerized tomography, to diagnose blocked ducts. This allows us to conduct two special tests known as dacryocystography and dacryoscintigraphy, which involve passing a contrast dye through the tear drainage system and then taking images to identify the location and cause of the blocked duct.
When to Schedule an Appointment
Tears serve an important purpose – they keep the eye moist and clean so that bacteria, viruses, and fungi do not infect the eye. When a blocked duct prevents the eyes from draining properly, recurrent infections are likely to occur. It is important to see one of our eye doctors if your eye is frequently infected, seems to be excessively watery, or if your vision is blurry. Dr. Wenjing Liu is an eyelid and tear duct specialist (also known as an Oculoplastic specialist) that can address all your concerns and treat your condition.
Treatment for Blocked Eye Ducts
In treating a blocked tear duct, the goal is to remove the obstruction so that the tear drainage system begins to flow properly once again. Our eye doctors typically recommend a conservative approach to treat blocked tear ducts, as most cases will resolve spontaneously within a few months.
In newborns, blocked ducts usually resolve during the first few months of life. If they do not, our eye doctors may teach the parents how to perform a special massage technique designed to help the nasolacrimal duct open up. When the blocked duct occurs in children or adults as a result of injury, it is best to give it time, as the blockage may resolve after swelling decreases.
Minimally Invasive Treatment Options
When time does not resolve the issue, the next step is to attempt one of the minimally invasive treatments available. Our eye surgeons are experienced with new techniques that can solve your condition without an intrusive surgery:
- Dilation, probing and irrigation: As mentioned above, this may also be used as a diagnostic test to identify the cause of the blockage. During this treatment, the tear duct opening is gently widened using a special dilation instrument. Then a tiny, thin probe is inserted through the opening and threaded through the entire tear drainage system until it exits via the nose. This treatment is usually very successful when used on infants and adults who have a blocked tear duct as a result of a constricted puncta. After the treatment, antibiotic eye drops may be prescribed to minimize the risk of infection.
- Balloon catheter dilation: This treatment may be performed if tear ducts are blocked due to scarring or inflammation. During the procedure, a small catheter with a balloon on the tip is inserted into the lower nasolacrimal duct via the nose. Once the catheter is in place, the balloon is inflated and deflated, which serves to widen the passage to remove the blockage.
- Stenting or intubation: During this treatment, a small tube is threaded through one or both of the punctual openings and passed through the tear drainage system until it exits through the nose. The tubes are then left in the eye(s) for up to 3 months.
When is Surgery Necessary?
Surgery should only be performed if a less invasive treatment did not resolve the blocked tear duct. Dr. Wenjing Liu sees many patients each year with similar conditions and will prepare a personalized treatment plan for you to give you the best possible outcome.
Dacryocystorhinostomy, the surgical technique used to resolve blocked tear ducts, can be performed under general or local anesthesia. The goal of this surgery is to create a new passageway for tears to drain into the nose. The new passageway will bypass the nasolacrimal sac completely, as this is the most common site of persistent blockages that cannot be resolved through less invasive methods. Stents or tubes are used to hold the newly created passageways open while the body heals, which can take up to 3 months.
When performed by one of our skilled eye surgeons, dacryocystorhinostomy can be a very effective treatment for blocked ducts. Because the surgery addresses such a delicate and important facial structure, it is important that it is performed by an ophthalmologist or eye surgeon who is highly experienced at performing dacryocystorhinostomy, particularly an Oculoplastics specialist.